Pulmonology Coding Alert

Question: I submitted documentation with a line-itemized claim for three same-day services/procedures as follows:

--99233-25 (Hospital follow-up with modifier for same day of procedure)

--32002-50 (Thoracentesis w/cath with modifier for bilateral procedure at same operative session)

--32002 (Thoracentesis w/cath, no modifier). Problem: Medicare paid for the first and second line but denied the third line stating, "Payment adjusted because the payer deems the information submitted does not support this level of service." Did I bill this correctly?


Pennsylvania Subscriber
Answer: You actually billed Medicare for four items. Reporting the thoracentesis (32002, Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]) as you did using two lines and modifier 50 (Bilateral procedure) indicates the pulmonologist performed three taps, a medically unlikely event. If the physician only performed bilateral thoracentesis, which is more likely, you should have reported the bilateral services using a single line (a single unit), with modifier 50. Medicare pays 150 percent for this item (100 percent for the "first side" and 50 percent for the "second side"). Some coders incorrectly report bilateral services to Medicare using two separate line items (appending modifier 50 to one of the items). Action: Before you assume the pulmonologist performed three taps, check with the physician or documentation. If he indeed performed two taps, do not resubmit the claim because Medicare paid appropriately for the bilateral services. If the physician performed three taps, resubmit the claim using modifier 59 (Distinct procedural service) on the third thoracentesis (32002) to indicate that the pulmonologist performed the tap at a separate session. Include a simple explanation of the separate sessions and attach copies of the separate operative reports showing the reason for the subsequent tap.