Radiology Coding Alert

Question: Can I use 32554 when the physician performs a diagnostic thoracentesis or when fluid removed is less than 300 cc, and can I use 32556 when he performs a therapeutic drainage and fluid removed is more than 300 cc?

Kansas Subscriber

Answer: Your coding should be based on the method rather than the amount of fluid removed. You also need to take the use of imaging guidance into account when choosing your codes.

For the thoracentesis, review the documentation to confirm imaging guidance was used, which is highly probable when coding for a radiologist. Choose between these two codes for the aspiration service:

·         32554, Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance

·         32555, … with imaging guidance.

Use and documentation of imaging guidance also will determine which pleural drainage code is appropriate:

·         32556, Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance

·         32557, Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance.

The code definitions for 32556 and 32557 specify use of an indwelling catheter as part of the fluid removal service. An indwelling catheter is a small flexible tube placed with one end in the chest and the other end outside the skin to allow for drainage.

Imaging: Codes 32555 and 32557 include imaging guidance. Consequently, you should not report a separate code for the imaging guidance used to perform these pleural aspiration and drainage procedures. Codes 32554 and 32556 are appropriate when imaging guidance was not used.