ED Coding and Reimbursement Alert

Question: A patient reports to the ED via ambulance. The emergency medical technician (EMT) says the patient had sudden chest pain, rapid heart rate and rapid breathing. The physician orders a two-view chest x-ray, and diagnoses a spontaneous pneumothorax. Encounter notes indicate that the physician used "needle to chest for spontaneous pneumothorax." Notes indicate the encounter included a level-five E/M service. How should I code this encounter?Montana SubscriberAnswer: You physician performed a needle thoracentesis for this patient's collapsed lung. On the claim, report the following:32421 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) for the thoracentesis71020 (Radiologic examination, chest, 2 views, frontal and lateral;) for the x-rayModifier 26 (Professional component) appended to 71020 to show that the physician is only billing for his interpretation of the x-ray99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed [...]