Pulmonology Coding Alert

Question: We use 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]) for a thoracentesis when the tube is removed right away. We use 32020 (Tube thoracostomy with or without water seal [e.g. for abscess, hemothorax, empyema] [separate procedure]) when the tube is left in place, and the physician has to check it over several days. Is this correct coding?

Oregon Subscriber Answer: In this case, the procedure coding depends on the reason the procedure is being performed, e.g., the patient's diagnosis. The reported ICD-9 code identifies the medical necessity for the procedure. Code 32002 generally represents the diagnostic or therapeutic removal of fluid that has entered the pleural cavity through a perforation in the chest wall or the pleura. A catheter is inserted to drain the fluid from the pleural cavity and allow for the lung's reinflation. The length of time the chest tube is left in place can vary depending on how long it takes for the lung to re-expand. Lung re-expansion is routinely evaluated using serial chest x-rays. The catheter may be inserted to treat a pneumothorax (512.8), for example, and removed after the drainage or re-inflation is complete. On the other hand, 32020 is reported when a tube thoracostomy is performed. The pulmonologist inserts a tube larger than a catheter and sutures it in place, most commonly to treat an empyema (510.9). Empyema is the presence of pus in the pleural cavity, usually the result of a primary infection of the lungs. The physician inserts the tube to assist with drainage of the abscess or empyema. The pulmonologist chooses the site of the chest tube insertion to maximize lung drainage. Again, when the chest tube is removed will vary depending on the patient's condition.

The answers to Reader Questions and You Be the Coder were provided by Carol Pohlig, BSN, RN, CPC, at the University of Pennsylvania department of medicine in Philadelphia; and Mary Mulholland, RN, BSN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia.