Optimize Reimbursement for Screening and Therapeutic Thoracentesis Procedures
Published on Sun Oct 01, 2000
Thoracentesis may be performed either for diagnosis or therapeutic purposes, and also may include related procedures in addition to evaluation and management (E/M). You should understand the reason for the procedures first, then document the various diagnoses carefully to eliminate chance of denial.
The two pleurae covering the lungs where they meet the inside of the chest wall help reduce friction during breathing, says Gregory Tino, MD, FACC, assistant professor of medicine at the University of Pennsylvania in Philadelphia. Fluid can get trapped between the visceral pleura (next to the lungs) and parietal pleura (next to the chest wall). When this happens we often order a thoracentesis to help with the diagnosis or treatment.
To perform a thoracentesis, the pulmonologist inserts a small needle between the patients ribs into the space between the two pleurae. He or she drains the fluid and usually sends the fluid to a laboratory for cultures and other diagnostic tests.
Sometimes disease, such as cancer, causes fluid to build up and the patient experiences shortness of breath or coughing. When this happens, we do a therapeutic thoracentesis, says Tino. In this case we are more interested in getting the fluid out, letting the lungs expand and helping the patient get relief.
Understanding the Thoracentesis Service Codes
The physicians notes indicate whether the thoracentesis is done for diagnostic reasons or therapeutic ones, says Cynthia Somma, CMM, CPC, office manager for Nassau Queens Pulmonary Associates, PC, a private practice group in New Hyde Park, N.Y. In a diagnostic thoracentesis (32000, thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent), fluid is removed and sent for testing. Therapeutic thoracentesis (32002, thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]) occurs when the main reason the fluid is removed is so the patient can breathe better.
Usually the initial patient visit will focus on obtaining accurate medical information to help us decide if a thoracentesis is the most appropriate procedure, says Mary Mulholland, RN, BSN, CPC, reimbursement analyst in the department of medicine at the University of Pennsylvania in Philadelphia. Code the initial evaluation and management (E/M) with the appropriate E/M code (99201-99233). The choice of codes depends on the location of the service, nature of the service performed, and the intent of the requesting physician (in transferring care of the pulmonary problem to the pulmonologist). If the pulmonologist performs the thoracentesis on the same day as the E/M service, be sure to append the -25 modifier (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
In many cases the physician evaluates the patient and then performs the [...]
