# CPT 32555 VS 32557



## afryberger (Feb 11, 2020)

Hello, I'm going back and forth between the two codes because they say they connected them to suction with a catheter, however they remove it at the end. Thoughts? Thanks in advance! 


The patient was positioned in the upright sitting position in the 
 angiographic suite. Then ultrasound of the right posterior chest was 
 performed. An appropriate site for access was identified and 1% 
 lidocaine was administered. A 5 Fr sheathed needle was then inserted 
 into the pleural space under direct sonographic guidance. Concurrent 
 real-time ultrasound visualization was performed of the needle 
 entering the effusion, and a permanent access image was saved to PACS.

 Tubing was then connected to the catheter hub and attached to 
 suction. The catheter was secured in position and 680 milliliters of 
 serous yellow  fluid was drained. The tube was removed and a sterile 
 dressing was applied. The patient tolerated the procedure well and 
 was transferred to recovery without immediate post procedure 
 complication.


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## mk2001 (Feb 11, 2020)

It sounds like the catheter itself stayed though so would that make it an indwelling catheter to use 32557?


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## fwnewbie (Feb 11, 2020)

Was the proposed procedure listed as thoracentesis? I question the wording used here. They start with " needle", attach "tubing", then switch to "catheter".  
The terms needle and catheter can be used interchangeably and tubing and catheter can also be used that way.  But in this case I think the "catheter" refers to the needle used (the "needle" part is used to puncture and the "5 Fr sheath" is advanced while the sharp pointed needle is withdrawn to prevent inadvertent puncture of the other tissue.  My take is the catheter being removed is actually the sheath being removed so there is nothing left inside the patient after draining the effusion.
Your provider might need to review/reword this procedure report before filing.


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## wisibyusha (Feb 11, 2020)

Hi, at first it sounds like aspiration because it says the catheter was then removed at the end of the procedure. However,  if you read the operative report carefully the procedure done is drainage because the catheter is secured in position and YELLOW FLUID WAS DRAINED yeah, DRAINED. So this key word can be a clue to cross out the 32555 option and jump on 32557 since imagining guidance was utilized.


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## wisibyusha (Mar 12, 2020)

Have you read the OR? this is not incision and drainage in the integumentery section. It is type of thoracentesis.


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## such78 (Mar 12, 2020)

32555 for pleural effusion, 32557 for pneumothorax. 
32555 is for puncture of the pleural space with the insertion of a needle or catheter placed for aspiration of fluid. After the procedure is complete, the catheter or needle is removed. 32557 for placement of a non-tunneled chest tube into the pleural space for drainage, and will remain in pleural space.


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## khemchand (Mar 16, 2020)

32555. Catheter removed at the end of procedure.


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