Pulmonology Coding Alert

Question: Our pulmonologist performed a level-four E/M on an established patient, resulting in the performance of a thoracentesis via pleural cavity puncture on a patient. I reported 32000 for the procedure and received a denial. What's going on?

Missouri Subscriber

Answer: The code you used (32000, Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) is not in CPT 2008. You'll have to resubmit the claim with the new code for the service. On the claim, report the following:

• 32421 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) for the thoracentesis

• 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to 99214 to show that the E/M and procedure were separate services.

Remember: Code 32421 is identical to 32000. Just be sure to report 32421 instead of 32000 from now on for this procedure.

Also, be sure to note these other changes to the thoracentesis code set that you'll need to know for 2008:

• CPT deleted 32002 (Thoracentesis with insertion of tube with or without water seal [e.g. for pneumothorax] [separate procedure]) and replaced it with 32422 (Thoracentesis with insertion of tube, includes water seal [e.g., for pneumothorax], when performed [separate procedure]).

• CPT deleted 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]) and replaced it with 32551 (Tube thoracostomy, includes water seal [e.g., for abscess, hemothorax, empyema], when performed [separate procedure]).