Pulmonology Coding Alert

Question: Our pulmonologist placed an anterior chest tube in the patient. He made a 1-cm incision in the second intercostals space about 7 cm to the right of the midline. He then passed a 20F tube in the anterior chest. What is the most appropriate code for these services -32002 or 32020?

South Dakota Subscriber

Answer: Physicians typically perform 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., pneumothorax] [separate procedure]) as a quick solution when a patient has an accumulation of fluid and/or air in his pleural space.

As illustrated in CPT, the physician punctures a space between the ribs (i.e., intercostals space) and inserts a tube into the pleural space. The physician then attaches a syringe to the catheter for the removal of fluid and/or air.

You should report 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]) when the physician leaves the tube in place. The physician places a tube with a trocar in the pleural space through a puncture in the intercostals space. The physician withdraws the trocar and then sutures the tube in place to drain air and/or fluid through a thoracic drainage system.

This will help the lung to re-expand. Since the scenario described in the question implies that the physician left the tube in place, you may report 32020 if your documentation of the procedure supports this.