Oncology & Hematology Coding Alert

Question: Our provider drained pleural fluid and performed a needle pleural biopsy on a patient with lung cancer. Is 32554 the correct way to report this service, and can we separately report the biopsy?

Oklahoma Subscriber

Answer: If your provider drained fluid from the patient’s pleural cavity (as opposed to aspirating the fluid by performing a thoracentesis), you cannot use 32554 (Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance) or 32555 (… with imaging guidance).

Instead, you would use 32556 (Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance) or 32557 (… with imaging guidance) for the drainage. Typically, your provider will perform the pleural drainage and biopsy the fluid drained at that session.

If this is the case, you should not report 32400 (Biopsy, pleura, percutaneous needle) together with 32556 or 32557. However, if the oncologist performs the two services separately, and your provider has documented this and the need for the separation of services, you should append modifier 59 (Distinct procedural service) or another appropriate, more specific modifier to indicate both should be paid separately.

You should also link the service(s) to J91.0 (Malignant pleural effusion), obeying the Code first instruction that accompanies it telling you to sequence the underlying neoplasm before the pleural effusion. In this case, you’ll choose a code from C34.90 (Malignant neoplasm of unspecified part of unspecified 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) as documented by your provider.