Pulmonology Coding Alert

Question: Is there a code for insertion of a chest tube using the c-arm? Does it matter how the physician inserted the tube?


Kentucky Subscriber

Answer: You should use 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]) to report the chest tube insertion regardless of whether or not your pulmonologist used a c-arm during the procedure.

When your physician's documentation states that he used the c-arm, it indicates that he used fluoroscopy during the chest tube insertion. If a radiologist performed the fluoroscopy, the radiologist should report 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]). If the pulmonologist performed the fluoroscopy without the assistance of a radiologist, the pulmonologist should report 76000.

Tip: The physician must issue a separate report focusing specifically on the fluoroscopy usage, or Medicare and other payers will not pay for the fluoroscopy.