Pulmonology Coding Alert

Observe these pointers for reporting additional procedures.

Last month, we provided a refresher on accurately reporting thoracentesis. In this issue, we'll address how to report other procedures that are done along with thoracentesis, such as the radiological assistance for the procedure and E/M services. Read on for more advice on boosting your coding accuracy and recouping deserved pay for these additional services.

Know the basics: Thoracentesis is a procedure done under local anesthesia to remove fluid or air present in the pleural space. Depending on whether the procedure is done for diagnostic or therapeutic purposes, you report thoracentesis with 32421 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) or 32422 (Thoracentesis with insertion of tube, includes water seal [e.g., for pneumothorax], when performed [separate procedure]).

Report the Radiologic Assistance

Your pulmonologist may take a chest x-ray to confirm the effusion. In addition, he/she may utilize ultrasound guidance to place the catheter for adequate drainage.

You report the x-ray with 71020 (Radiologic examination, chest, 2 views, frontal and lateral) and the ultrasound guidance with code 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). And you would append modifier 26 (Professional component) to both 71020 and 76942 to indicate that you are billing only for the professional component of the service when services are performed in facility-based settings.

"Be sure to mention the US guidance and document the necessary details of visualization. A written report signed by the interpreting physician should be considered an integral part of a radiologic procedure or interpretation including CXR," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.

Crucial: Only one provider can bill for the chest x-ray. Generally, the radiologist in the facility will provide the formal interpretation and report, along with the claim for this service. Make sure you do not bill for the chest x-ray in this case. However, if your radiologist is not reporting for it, you can provide the official report of interpretation and bill for the service.

Capture Any E/M Services

Pleural effusion may precipitate respiratory distress in a patient as it presses upon the underlying lung tissue. Say you have a patient who reports with an acute onset of breathlessness. Your pulmonologist may evaluate the patient and decide to go in for a pleural tap after an urgent chest x-ray examination. The pulmonologist does a needle tap to determine the cause for the accumulation of fluid.

In this instance, you would report 32421 for the pleural tap; you also report 99214 (Office or other outpatient visit for the E/M of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity...) for the E/M.

You would append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to 99214 to show that the E/M and thoracentesis are separate services.