General Surgery Coding Alert

Coding for thoracic procedures involving thoracotomy, which requires opening the patient's chest, and thoracoscopy, a procedure similar to laparoscopy that is performed in the chest rather than the abdomen, can prove a challenge. It's confusing enough that the CPT manual offers a choice of more than 60 codes related to these procedures, let alone the fact that many thoracic procedures can be performed as thoracotomies or thoracoscopies. Medicare and some commercial carriers, in addition, may have specific regulations governing many thoracic procedures, such as lobectomy and bronchoplasty performed during the same session, thoracoscopy converted to an open procedure and multiple diagnostic and surgical thoracoscopy.
 
Most thoracic procedures are listed in CPT 2002 under the Respiratory System"" section; ""Lungs and Pleura"" subsection; ""Incision "" ""Excision"" and ""Endoscopy.""
Incision (32000-32225)
Incision codes frequently do not involve incision. If a patient has fluid in the pleural cavity for example the surgeon may aspirate the cavity and send samples of the aspirated liquid to pathology or cytology. This procedure is reported using 32000 (thoracentesis puncture of pleural cavity for aspiration initial or subsequent).
 
If a patient has air or gas in the pleural cavity the condition is known as a pneumothorax. This can occur spontaneously as a result of trauma or a pathological process says M. Trayser Dunaway MD FACS a general surgeon in private practice in Camden S.C. Possible causes of pneumothorax include: the lung may have spontaneously collapsed the surgeon or radiologist may have punctured the lung while taking a needle biopsy or the surgeon placed a central line and the needle strayed from inside the subclavian vein and punctured the lung. A surgeon treating pneumothorax anesthetizes the skin on the side of the chest and slides vacuum catheters of various sizes into the thoracic cavity and sucks out the air to relieve the pressure and allow the lung to re-expand. This procedure is reported using 32002 (thoracentesis with insertion of tube with or without water seal [e.g. for pneumothorax][separate procedure]). If the pneumothorax persists or returns chemical pleurodesis (32005) may be required.
 
If a patient has blood and air in the pleural cavity the condition is known as a hemothorax. Pus may also fill the space if the patient has an abscess or empyema. Both blood and pus are thick liquids that must be sucked out of the pleural space using a larger catheter. This procedure is reported using 32020 (tube thoracostomy with or without water seal [e.g. for abscess hemothorax empyema][separate procedure]).
 
Codes 32002 and 32020 are separate procedures and should only be billed if they are the only procedures performed during the operative [...]