Radiology Coding Alert

Question: Our physician performed an exchange for chest tube in a patient with previously placed chest tube (32557). He exchanged the tube because it had migrated out of the pleural space. He passed a guide wire through the tube, removed the tube and placed a new tube over the wire and into the appropriate position in the pleural space. Can you please suggest a code for the exchange of the chest tube?

Codify Subscriber

Answer: Replacement of the non-tunneled catheter performed on a day other than initial insertion represents a coding challenge. If performed at an alternate site, you can report 32557 (Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance). You have not described any imaging guidance, so you may consider code 32556 (Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance). You won’t have any CPT® code to represent non-tunneled pleural catheter replacement through the existing site. 

In the scenario described, a guide wire was placed through the tube. After this, the tube was removed and a new tube was placed over the wire. The tube was placed into the appropriate position in the pleural space. Thus, 32556 or 32557 with modifier 52 (Reduced services) will represent the reduced service of the incision not being required. An unlisted code may be another option, (32999, Unlisted procedure, lungs and pleura). Be sure to check with the payer to determine which option is acceptable, if any.

Non-tunneled chest tubes: Your physician may place a non-tunneled chest tube in a patient in palliative care with poor prognosis and is not a candidate for other treatment options. The non-tunneled chest tubes are likely to become dislodged or infected and are not recommended for long-term management.