Wiki "Chest tube advancement" CPT needed

[ca_cpc]

Hi all - I work in a primary care office and am feeling a little out of my league here. We have a patient who had a chest tube placed while in the hospital and has been coming into our office for "Chest tube advancement" per the instruction of his surgeon, who also gave procedural instruction to our provider. The main portion of the procedure note is as follows:

"area cleaned with hibaclens type surgical prep. subcutaneous tissues infiltrated 10 cc of 1% lido with epi - much leaking was noted. Anesthesia was obtained, tube advanced an inch, anchor suture placed with 2-0 silk, tied, ends wrapped and tied around tube at skin level. multiple ties. Repeated both sides, then remaining sutures also tied. SDD applied with tape, Pt tolerated well, return in 5 days (holiday week) for readvancement."

I have no idea how (or if) I should be coding this. Any guidance you could give me would be greatly appreciated. Thank you!

 

[haaskimberly]

Re: I have no idea how (or if) I should be coding this. Any guidance you could give me would be greatly appreciated.

There is no specific CPT code for the chest tube advancement procedure which you describe. Your best option would be to use an unlisted code for the anatomical area, which would be 32999 (Unlisted procedure, lungs and pleura). Then because this is an unlisted procedure, you will need to supply the specific description "chest tube advancement" on the claim (line item notes).

Most insurance carriers would also appreciate or require that you attach a brief statement providing a comparable code to establish work value involved. That is tricky here, because this is certainly much less work and risk than the original insertion of the chest tube (32551, RVU = 4.93). I would suggest you discuss this with your physician and come to an agreement about what percentage of the work of 32551 he feels is involved in the advancement procedures, and then write up a brief statement adapting what you have written here and attach that statement and a copy of the records when you submit the claim.
For example:
"32999 chest tube advancement. Performed at request of surgeon after detailed direction/training. Procedure typically involves local anesthesia, advancing tube approximately an inch, suture and secure, general wound assessment and care, and redressing. Comparable code -- estimate 25% of work of 32551."

Remember that all assessment of the wound and chest tube site is included in the surgical procedure code; it does not qualify as a significant, separately identifiable E/M service, so a separate issue will need to be addressed to qualify to bill an E/M service with modifier 25 appended. (See NCCI Policy Manual, chapter 1, section D, "The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service.")

Your only other option would be to simply code the E/M instead of a procedure service, and ensure that the key components are well supported in the documentation to support the level of E/M billed. I personally think the unlisted procedure is the better option.