Wiki Cpt thoracentisis billing

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blane

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Good morning!!! I have been working for the last 45 minutes on this procedure and i am not getting anywhere. I am the lead coder for a small radiology practice where we just bill for the reading of the procedures he performs. For some reason i can't get the 32555 thoracentisis paid for. Any and all suggestions will be appreciated!
 
Yes. He performs them at the hospital and then we bill for just the reading of it. The hospital bills for the procedure.
 
Radiological guidance is bundled. Radiologist would not bill the cpt code for the procedure they did the guidance for. The surgical code specifically says "with imaging guidance"
 
So does that mean the reading for the procedure is included? I know we bill for other procedures that include imaging and they get paid.

:)
 
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I'm curious what reading was done. My understanding is a tech runs the machine, which has a live picture the surgeon references when performing the procedure to make sure the needle is going to the correct place.


Here is the paragraph from the NCCI manual discussing it.

Physicians should not report radiologic supervision and interpretation codes, radiologic guidance codes, or other radiology codes where the radiologic procedure is integral to another procedure being performed at the same patient encounter. Procedure to procedure edits that bundle these radiologic codes into the relevant procedure codes have modifier indicators of “1” allowing use of NCCI-associated modifiers to bypass them. An NCCI-associated modifier may be used to bypass such an edit if and only if the radiologic procedure is performed for a purpose unrelated to the procedure to which it is integral. For example, fluoroscopy is integral to a cardiac catheterization procedure and should not be reported separately with a cardiac catheterization. However, if on the same date of service the physician performs another procedure in addition to the cardiac catheterization, the additional procedure requires fluoroscopy, and fluoroscopy is not integral to the additional procedure, the fluoroscopy procedure may be reported separately with an NCCI-associated modifier.
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Me too!

I work for a small radiology practice and am working on a Thoracentesis claim. We do not usually bill for these, but I'm stuck. I know the guidance can't be billed separately. But would anyone here happen to know if there is a code that can be used for marking the site? I'm a newbie and haven't been coding long. I am not familiar.
 
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