ED Coding and Reimbursement Alert

Question: One of our ED physicians performed a chest tube insertion for a patient she diagnosed with a non-traumatic hemothorax. How should we report this encounter?


Indiana Subscriber

Answer: To choose the proper codes for this encounter, you-ll need to discover whether the physician used fluoroscopy during the procedure. This will affect your CPT code choice.

Check the physician's notes; if she did not use any fluoroscopy on the patient, you should:

- report 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]) for the hemothorax.

- link ICD-9 code 511.8 (Other specified forms of effusion, except tuberculous [excludes traumatic]) to 32020 to represent the patient's hemothorax.

If the physician used fluoroscopy during the procedure without the help of a radiologist, you should:

- report 32020 for the chest tube insertion.
- report 76003 (Fluoroscopic guidance for needle placement [e.g. biopsy, aspiration, injection, localization device]).
- link ICD-9 code 511.8 to 32020 and 76003 to represent the patient's hemothorax.
- include a separate report that explains why and how the physician used fluoroscopy. Without this documentation, Medicare and other insurers will be reluctant to pay for the fluoroscopy.

Exception: If an ED physician needs fluoroscopy during a chest tube insertion, she may call on a radiologist to provide that service. When this happens, forget about reporting the fluoroscopy. If the physician performs a chest tube insertion with fluoroscopy provided by a
radiologist, you can only report 32020; the radiologist charges for the fluoroscopy.