Radiology Coding Alert

Question: Which code is appropriate for an ultrasound guided thoracentesis?

South Carolina Subscriber

Answer: If the radiologist performed both the thoracentesis and the guidance, you may report both separately.

Guidance: For the ultrasound guidance, report 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).

Remember that ultrasound guidance procedures "require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized," according to CPT's "Diagnostic Ultrasound" guidelines.

Procedure: For patients who undergo thoracentesis, removal of excess fluid or air in the space between the lungs and chest wall, the medical record should describe clearly how the physician removed the fluid and which equipment he used. This information will help you choose the correct code.

If the radiologist uses a syringe and needle during the procedure, but does not insert a catheter, look to 32421 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent). If the physician inserts a catheter in the pleural cavity, the encounter instead merits 32422 (Thoracentesis with insertion of tube, includes water seal [e.g., for pneumothorax], when performed [separate procedure]).

32421 example: The radiologist inserts a needle in the patient's pleural cavity and obtains a syringe full of fluid, which he sends to the laboratory for analysis.

32422 example: The radiologist inserts a catheter over a needle into the pleural cavity, withdraws the needle, and drains the pleural fluid. The catheter remains in place until the procedure is over, and then the physician removes it.