ED Coding and Reimbursement Alert

Question: Our ED physician performed thoracentesis via pleural cavity puncture on a patient in early January. I reported 32000 and received a denial. What's going on?

Missouri Subscriber

Answer: The code you used (32000, Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) is not in CPT 2008. You-ll have to resubmit the claim with the new code for the service, 32421 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent). C ode 32421 is identical to 32000. Just be sure to report 32421 instead of 32000 from now on for this procedure.

ED coders will also want to note other changes to the thoracentesis code sets in CPT 2008, because the AMA changed descriptors and code numbers for these procedures. Check out this rundown of the other thoracentesis code changes you-ll need to know in 2008:

Deleted: 32002 -- Thoracentesis with insertion of tube with or without water seal (e.g. for pneumothorax) (separate procedure)

Added: 32422 -- Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure)

Impact: Code 32422 is nearly identical to code 32002 and includes a water seal, if used. The change in language -- from "with or without water seal" to "includes water seal" -- makes for more accurate coding.

Deleted: 32020 -- Tube thoracostomy, with or without water seal (e.g., for abscess, hemothorax, empyema) (separate procedure)

Added: 32551 -- Tube thoracostomy, includes water seal (e.g., for abscess, hemothorax, empyema), when performed (separate procedure)

Impact: Code 32551 includes water seal. This change was mostly to tighten up coding for the procedure. The physician almost always uses a water seal during a chest tube insertion.