Pulmonology Coding Alert

Question: The pulmonologist visits with a patient with malignant cancer of the main bronchus who is suffering from a probable malignant pleural effusion. The physician performs a thoracentesis with insertion of tube. What codes should I use on the claim?

Indiana Subscriber

Answer: Report the following for this encounter:

• 32422 (Thoracentesis with insertion of tube, includes water seal [eg, for pneumothorax], when performed [separate procedure]) for the thoracentesis
• 162.2 (Malignant neoplasm of trachea, bronchus and lung; main bronchus) to represent the underlying cancerous condition
• 511.81 (Malignant pleural effusion) to represent the malignant effusion. You must wait for the final diagnosis from cytology on the pleural fluid before you code it.

Remember: You should use 511.81 when the pleural fluid is cancerous. Experts describe a malignant pleural effusion as a condition caused by a cancerous invasion of the pleura -- either due to cancer within the lung or metastatic disease from any other organ. Make sure you code for the source of the primary tumor as well.

History: Code 511.81 replaced 197.2 (Secondary malignant neoplasm of respiratory and digestive systems; pleura) for a malignant pleural effusion.