General Surgery Coding Alert

Question: When treating a trauma patient with bilateral pneumotheraces (860.0), what is the most appropriate code for placement of chest tubes, both right and left?

Bobbie Breaux, Office Manager
Charles W. Breaux, Jr., MD
Grand Junction, CO

Answer: The correct CPT code for this procedure is 32020 (tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema][separate procedure]), says Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management Inc., a coding and reimbursement consulting firm in Spring Lake, NJ. In this case, because the procedure was performed bilaterally, it should be coded 32020-RT on the first line of the HCFA 1500 claim form, and 32020-LT-50 on the second line. The -50 modifier indicates that the procedure was bilateral.

Coders also need to check with their carriers to determine if they prefer one-line entry or two for bilateral procedures. If the carrier accepts one-line entries, the procedures should be coded 32020-50 with a 2 in the units box, says Karen Evans, RN, CPC, who notes that the carriers computer may require the number in the units box to generate the second payment.