ED Coding and Reimbursement Alert

Question: How should I code the following situation: The physician uses the thoracentesis needle and catheter mechanism to enter the pleural space. The physician obtains auburn-colored fluid from the wound, which is clear and not bloody and then uses intravenous tubing to drain about 400 cc into the Vacutainer. Code 32000 doesn't seem to apply. The CPT Assistant indicates that the physician wouldn't make an incision for a service reported by 32000. Should I report 32002?

Michigan Subscriber

Answer: You should report 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]). For this service, a catheter and stylet mechanism punctures the pleural space, and the physician removes the stylet and leaves the catheter in place. Your physician can remove multiple syringes of pleural fluid using this technique.

Code 32000* (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) more simplistically involves using a metal needle, which the physician sticks into the pleural space to remove one syringe of fluid. For the other relevant code, 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]), the physician makes the incision and inserts a formal chest tube.