Oncology & Hematology Coding Alert

Question: In a patient with lung cancer, who developed breathlessness, our physician drained pleural fluid and also did a needle pleural biopsy. Can we report code 32554 for these services?

Texas Subscriber

Answer: You should not report code 32554 (Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance) as this implies a pleural tap or thoracocentesis. In patients with large effusions, pleural drainage is the preferred method.

Two procedures were performed.  You will look at two codes: code 32400 (Biopsy, pleura; percutaneous needle) for pleural biopsy and 32556 (Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance) for pleural drainage with insertion of an indwelling catheter. However, code 32556 is bundled into code 32400.

Watch the bundle: You will not be able to report 32556 with 32400. If done at the same session, only 32556 is reported.

Typically this is all done in one session/visit.  However, if in the rare instance this was performed separately; one of the services first, and later in the day the patient presented in a separate visit or the physician saw them in the hospital a second time that day and performed the second procedure, you can attach modifier 59 (Distinct procedural service) to the CPT^® code 32400 to indicate both should be paid separately. Ensure that your physician clearly documents both procedures in either case and the reason and separation of the two sessions if in fact that was the case illustrating both procedures were distinct.

Diagnosis coding: Submit ICD-9-CM code 511.81 (Malignant pleural effusion) and 162.9 (Malignant neoplasm of bronchus and lung, unspecified) to report the patient’s malignant effusion and cancer. Under ICD-10, report the same with J91.0 (Malignant pleural effusion). Code 162.9 will get more specific (left, right or unspecified lung) with C34.90 (Malignant neoplasm of unspecified part of bronchus or lung), C34.91 (Malignant neoplasm of unspecified part of right bronchus or lung) or C34.92 (Malignant neoplasm of unspecified part of left bronchus or lung).