Pulmonology Coding Alert

Question: My pulmonologist uses ultrasound to assess the presence and size of a pleural effusion. He looks, and does the thoracentesis afterwards. I feel I should use 76604 to report the ultrasound. Would it be the appropriate code?

West Virginia Subscriber

Answer: First, the service described above is ultrasound-guided thoracentesis. Code 76604 describes a complete ultrasound of the chest and mediastinum used to view more than the presence and location of fluid. However, the correct code for ultrasound guidance during thoracentesis is 76942 (Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation). This  requires the use of an ultrasound device that can store and reproduce images. It also requires a physician report of interpretation describing what was visualized..