# Thoracostomy



## prabha

32421
  32551
  75989-26
  76942-2659

I have the above codes for the following procedure.Can we code 32551 for thoracostomy tube placement or can we code 32422 combining 32421 & 32551?

       Ultrasound Thoracentesis and Thoracostomy Tube Placement:

        66-year-old male status post 
       laryngopharyngectomy, esophagectomy with gastric pull up with
       recurrent bilateral pleural effusions and episodes of desaturation
       during.   Patient referred for image guided thoracentesis and
       thoracostomy tube placement.

       Initial US images demonstrated a large right-sided loculated
       pleural effusion.

       The posteriolateral left chest wall was then prepped and draped in
       the usual sterile fashion. After the administration of local
       anesthesia and under US guidance, access into the pleural effusion
       was obtained with an 18 gauge needle. Several cc's of
       serosanguinous fluid was aspirated. Samples were sent for culture
       and sensitivity, cytology, cell count and chemistry levels.       
       An Amplatz wire was advanced through the needle and coiled within
       the collection. The needle was removed and serial dilatation of
       the tract was performed. An 8 French multi-sidehole pigtail
       drainage catheter was then advanced over the wire and positioned
       with its distal pigtail coiled within the pleural effusion.

       Approximately 300 cc of serosanguinous fluid was then aspirated.
       After which, repeat ultrasound images demonstrated marked residual
       fluid within the left pleural space.

       Repeat US images confirmed good positioning of the distal pigtail
       within the loculated pleural effusion and demonstrated residual
       fluid within the left pleural space.

       It was decided to maintain the thoracostomy tube for
       further drainage.

       The catheter was secured to the skin with 2 0 prolene suture.  The
       catheter was flushed with 10 cc of normal saline and attached to
       Pleurovac drainage.  A sterile dressing was applied over the skin
       entry site.


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## dpeoples

prabha said:


> 32421
> 32551
> 75989-26
> 76942-2659
> 
> I have the above codes for the following procedure.Can we code 32551 for thoracostomy tube placement or can we code 32422 combining 32421 & 32551?
> 
> Ultrasound Thoracentesis and Thoracostomy Tube Placement:
> 
> 66-year-old male status post
> laryngopharyngectomy, esophagectomy with gastric pull up with
> recurrent bilateral pleural effusions and episodes of desaturation
> during.   Patient referred for image guided thoracentesis and
> thoracostomy tube placement.
> 
> Initial US images demonstrated a large right-sided loculated
> pleural effusion.
> 
> The posteriolateral left chest wall was then prepped and draped in
> the usual sterile fashion. After the administration of local
> anesthesia and under US guidance, access into the pleural effusion
> was obtained with an 18 gauge needle. Several cc's of
> serosanguinous fluid was aspirated. Samples were sent for culture
> and sensitivity, cytology, cell count and chemistry levels.
> An Amplatz wire was advanced through the needle and coiled within
> the collection. The needle was removed and serial dilatation of
> the tract was performed. An 8 French multi-sidehole pigtail
> drainage catheter was then advanced over the wire and positioned
> with its distal pigtail coiled within the pleural effusion.
> 
> Approximately 300 cc of serosanguinous fluid was then aspirated.
> After which, repeat ultrasound images demonstrated marked residual
> fluid within the left pleural space.
> 
> Repeat US images confirmed good positioning of the distal pigtail
> within the loculated pleural effusion and demonstrated residual
> fluid within the left pleural space.
> 
> It was decided to maintain the thoracostomy tube for
> further drainage.
> 
> The catheter was secured to the skin with 2 0 prolene suture.  The
> catheter was flushed with 10 cc of normal saline and attached to
> Pleurovac drainage.  A sterile dressing was applied over the skin
> entry site.




The doc calls it a thorocostomy so I would give him the benefit of the doubt and code it:
32551 (thoracostomy) this usually involves use of a trocar, not a needle.
75898 (includes u/s guidance)

I would not code both codes as there were not two procedures performed. The tube placement is a continuation of the procedure being performed, not a separate procedure.

The other possible code(s) scenario is
32422 (thoracentesis with tube) this usually involves a needle
76942

I hope this helps.


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