Pulmonology Coding Alert

Question: If a 9-French drainage catheter is placed over a needle into the pleural space to re-expand the lung following a traumatic pneumothorax, is this considered a tube thoracostomy (32020) or a thoracentesis with insertion of tube (32002)? What is the difference between these codes?

Alan Haber
Graduate Pulmonary Associates, Philadelphia

Answer: Report code 32020 (tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]). This code represents the insertion of a chest tube when a trocar (a sharp-pointed instrument equipped with a cannula) is used to puncture the space between the ribs into the pleural cavity. This allows insertion of a chest tube via a thoracic drainage system to drain air and/or fluid from the pleural space, which, in turn, promotes lung re-expansion.

Code 32002 (thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]) addresses removing accumulated fluid or air from the pleural space by puncturing the space between the ribs. A tube is then inserted and a syringe attached to the catheter for the removal of fluid and/or air. This procedure does not specifically promote lung re-expansion.

Editors note: Cynthia DeVries, RN, BSN, CPC, a coding coordinator with the Lee Physician Group, a 42-physician practice in Ft. Myers, Fla., answered this question.