Pulmonology Coding Alert

Question: If a pulmonologist is performing a thoracentesis with imaging guidance where an assisting radiologist performs the ultrasound guidance for the procedure, should I bill 32555 for the pulmonologist? Or will it be coded under the radiology codes. This procedure is being done in a facility. 

Kansas Subscriber

Answer: Yes. You are now expected under the 2013 CPT® codes to bundle imaging guidance with interventional procedures. There were two new codes introduced to report a thoracentesis procedure performed by your pulmonologist. In your particular case, code 32555 (Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance)specifies that the procedure is “with imaging guidance.” The descriptor clearly states that any imaging guidance is included into 32555 and should not be reported separately.  Therefore, the pulmonology practice can enter into an agreement with radiology whereby a pulmonologist reports 32555; the pulmonology practice can attribute a portion of the payment for the radiologist’s professional service.

The bottom line is that reporting of imaging separately for 32554-32557 was discontinued after year 2013.

You may be confused, as previously codes 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) were billed by radiologists separately for performing thoracentesis and pleural drainage with image guidance.