ED Coding and Reimbursement Alert

Question: How do I code the following situation? A thoracentesis tray was brought to the bedside of a patient, and the pleural effusion on the right hemothorax was percussed out, and landmarks identified. The local anesthesia in the area of the posterior ninth rib at the costovertebral angle involved approximately 3cc of 1 percent lidocaine without epinephrine. The physician then used the thoracentesis needle and catheter mechanism to enter the pleural space. The physician obtained auburn-colored fluid from the wound, which was clear and not bloody and then used intravenous tubing to drain approximately 400cc into the Vacutainer.

Michigan Subscriber

Answer: You should report the service with code 32554 (Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance). For this service, a catheter and stylet mechanism is often used to puncture 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.

For thoracentesis that is performed under imaging guidance, use code 32555 (Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance)Both of these are new codes in CPT^® 2013.