Radiology Coding Alert

Question: If we report 32552 for chest tube removal, may we also code for inserting a replacement?

Arkansas Subscriber

Answer: Typically, you would not bill separately for a normal chest tube removal. The procedure takes just a few seconds, and payers include your reimbursement as part of any other services provided on that date, such as E/M or in this case the new tube placement.

You would use new code 32552 (Removal of indwelling tunneled pleural catheter with cuff) only if your radiologist removes a special kind of chest tube that is tunneled under the skin. If the physician removes a tunneled catheter and replaces it with a new tunneled catheter, you should bill both 32552 for the removal and 32550 (Insertion of indwelling tunneled pleural catheter with cuff) for the placement.

If the physician removes a tunneled catheter and replaces it in the same location with a non-tunneled chest tube (32551, Tube thoracostomy, includes water seal [e.g., for abscess, hemothorax, empyema], when performed [separate procedure]), you can't bill for both services.CPT's "separate procedure" designation means that 32551 is an "integral component" of other procedures at that site.

Exception: If the physician removes a tunneled pleural catheter and places a normal chest tube at a different location (such as the other side of the chest), you could bill both codes by appending modifier 59 (Distinct procedural service) to 32551.

Remember: You may report imaging guidance separately using 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation).