Pulmonology Coding Alert

Question: Can I use 32554 when our pulmonologist performs a diagnostic thoracentesis or when fluid removed is less than 300 cc and 32556 when he performs a therapeutic drainage when fluid removed is more than 300 cc?

Wichita Subscriber

Answer: CPT^® 2013 saw the introduction of four new codes to represent thoracentesis and pleural drainage. The earlier code sets 32420, 32421, and 32422 were eliminated. Instead, you have 32554 (Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance), 32555 (Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance) to report a thoracentesis procedure that your pulmonologist performs and 32556 (Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance) and 32557 (Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance)to report pleural drainage.

The new codes are very crisp and specific in their descriptions. You will no longer need to report imaging guidance separately. You will have to use one of the two codes for thoracentesis and pleural drainage depending on whether or not your pulmonologist used imaging guidance for the procedure performed.

Another plus to these codes is that you will no longer need to worry if a needle or a catheter was used for performing the thoracentesis procedure to determine the code as both are covered by the same set of codes.

You will need to use 32554 and 32555 when your pulmonologist performs an aspiration while 32556 and 32557 should be used when your pulmonologist uses an indwelling catheter for removal of fluid accumulated. So, you should base your code selection on the method/ approach used and the intent of the treatment rather than use volume of fluid removed as a basis for selection of the codes.