Pulmonology Coding Alert

Question: My pulmonologist inserted a chest tube and then instilled a fibrinolytic agent to break up multiloculations to free up an entrapped lung. Usually, I use 32560 for this procedure, which is for pleurodesis, not fibrinolysis. What code should I use for fibrinolytic agent instillation?

Illinois Subscriber

Answer: Starting Jan. 1, you will be able to use one of two new fibrinolytic agent instillation codes depending on the treatment day:

• For instillation on the initial day, use 32561 (Instillation[ s], via chest tube/catheter, agent for fibrinolysis [e.g., fibrinolytic agent for breakup of multiloculated effusion]; initial day).

• If the pulmonologist instills the fibrinolytic agent on a subsequent day, assign 32562 (... subsequent day).

Rule: Always report each day's code only once. Instillation, however, may occur multiple times per day over the course of several days. Currently, you have to code fibrinolysis as an unlisted procedure using 32999 (Unlisted procedure, lungs and pleura).

You are correct to code for instillation of an agent for pleurodesis with 32560 both now and in 2010. The code currently reads "Chemical pleurodesis [e.g., for recurrent or persistent pneumothorax]." The code will specify agent instillation through a chest tube or catheter and give an example agent, talc, in 2010: "Instillation, via chest tube/catheter, agent for pleurodesis (e.g., talc for recurrent or persistent pneumothorax)."

CPT 2010 further revises this code to remind you when it is appropriate to also code the chest tube insertion with 32551 (Tube thoracostomy, includes water seal [e.g., for abscess, hemothorax, empyema], when performed [separate procedure]).