Pulmonology Coding Alert

Know when to use 32000 and 32002 to avoid denials

You can make coding the pulmonologist's thoracentesis procedures a breeze if you learn how to distinguish between therapeutic and diagnostic services, coding experts say.
 
When the pulmonologist performs a thoracentesis for diagnostic purposes, report 32000 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent), says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. For example, the physician uses a needle to remove a patient's pleural fluid (511.9, Unspecified pleural effusion) and submits the fluid for testing. In other words, the physician removed the fluid only for diagnostic testing, so you should report diagnostic code 32000.
 
Report 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]) for therapeutic thoracentesis services. Typically, the physician performs the procedure with a chest-tube insertion that drains excess fluid from the chest, which occurs in patients with shortness of breath (786.05), says Sarah Goodman, MBA, CPC-H, CCP, president of SLG Inc. Consulting in Raleigh, N.C. The physician may also send the fluid to a lab.

Document Fluid Removal

To support medical necessity, make sure the pulmonologist's notes indicate his or her reason for performing the thoracentesis. Also, the physician's notes should include procedure vital signs and a description of the patient's respiratory status, Mulholland says.
 
Specifically, the physician's notes should say how he or she removed the fluid. This documentation should help you differentiate between the thoracentesis codes. Suppose the pulmonologist punctures the patient's pleural space with a catheter and stylet. Then the physician removes the stylet and leaves the catheter in place, which allows for prolonged drainage of the pleural space. In that case, you would report therapeutic code 32002 because the physician inserted a tube and can withdrawal multiple syringes of fluid.
 
On the other hand, report 32000 when the pulmonologist sticks a needle into the pleural space to remove one syringe of fluid. Physicians can remove multiple syringes during a diagnostic thoracentesis, but usually physicians use only one syringe, says Charlie Strange, MD, FCCP, director of the medical intensive care unit at the Medical University of South Carolina in Charleston.
 
Generally, Medicare carriers pay more for 32000 if the physician performs the thoracentesis in the office, pulmonology coding experts say.
 
For instance, the Medicare carrier in Illinois, Wisconsin Physicians Services Corp., pays $78 for facility-based diagnostic thoracentesis procedures, and $176.59 for in-office diagnostic thoracentesis. For therapeutic thoracentesis, Illinois Medicare reimburses $116.82 regardless of the setting.