Pulmonology Coding Alert

Question: When my pulmonologist does a pleural tap with both diagnostic and therapeutic intentions at the same time (32000 and 32002), is there a way to get credit for 32000?


Nebraska Subscriber

Answer: You can report both 32000 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) and 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]) only if your pulmonologist performs both procedures on the same day.

The difference between codes 32000 and 32002 is the method your pulmonologist uses to sample the pleural fluid, not whether he performs the thoracentesis for diagnostic or therapeutic reasons. You should report each thoracentesis based on the method your physician uses.

Code 32000 represents removal of air or fluid through a trocar needle the pulmonologist places in the pleural space. Code 32002 represents the removal of air or fluid through a catheter that the pulmonologist inserts into the pleural space.

If your physician performs both procedures on the same day, the documentation must indicate the reason for each to support the medical necessity of services.

Although NCCI does not bundle these services, the carrier will most likely request the documentation to determine whether both services are medically necessary and therefore payable.

If Medicare decides to pay on both procedures, you'll receive 100 percent for the first service and 50 percent for the second (multiple-procedure rule). Private payers may only reimburse for one service per date, according to your contractual arrangements, so be sure to check with your individual carriers.