Chest Tube Placement CPT code: Coding Guidelines

Since there have been few changes with chest tube placement procedure codes, medical coders face a little difficulty in find correct CPT code. Earlier the codes where very clear enough to understand. But, with the revised codes and new codes we have to use them initially carefully, to understand for what procedure they should be coded. Now, let us check out the new and the revised Chest tube placement/insertion CPT code in Interventional radiology facility. These cpt codes for not as difficult to code as Nephrostomy tube placement or Transhepatic cholangiogram procedures. Once you understand them, you can easily code them. CPT code 32556 & 32557 are used for coding chest tube placement procedures.

Thoracostomy is a minimally invasive procedure in which a thin plastic tube is inserted into the pleural space — the area between the chest wall and lungs — and may be attached to a suction device to remove excess fluid or air. A chest tube may also be used to deliver medications into the pleural space.

A pleurodesis procedure is usually performed through a chest tube placed at the time of the thoracentesis.

image courtesy: https://www.nlm.nih.gov/

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Table of Contents

Chest tube placement CPT code (thoracostomy) Open procedures

There is only one revised code in this Procedure. CPT code 32551 is earlier used for percutaneous procedure for chest tube placement. But, with the new updates this codes has been revised and now it should be used only for open procedure. But, since this code has now almost deleted in interventional radiology, we have also check the new CPT codes for placement for Chest tube. So, keep in mind that we have separate new procedure codes for chest tube placement, so use 32551 CPT code only for open surgery procedure.

32551– Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure)

Sample coded Surgery Reports for medical coders

Description of CPT code 32556 & 32557 for non-tunneled Catheter

Now, we will introduce these new CPT codes 32556 and 32557, which are to be used for chest tube placement for non-tunneled pleural catheter or chest tube placement. It is very important to check whether the catheter is placed in non-tunneled or tunneled, since we have separate codes for each of them. Now, first we will checkout the main difference between these two code 32556 and 32557.

Percutaneous approach is used for placement of Chest tube for procedure code 32556 & 32557.. In this approach, a small puncture in the chest wall is made. Fluid is then drained from the pleura using a needle or catheter. A catheter (aka a tube) is then left in place to allow for continued drainage. Report CPT 32556 and 32557 codes for percutaneous chest tube insertion.

The difference between CPT 32556 and 32557 is whether radiology guidance is used. If the documentation supports ultrasound, fluoroscopy, CT, or MRI used to gain visualization of the chest and guide the placement of the needle/catheter, report CPT 32557. If these details are not mentioned in the note, report CPT 32556.

The CPT description for these codes includes the phrase “with insertion of indwelling catheter” which is referencing the fact that the catheter is left in place at the end of the drainage procedure. The other important word in the CPT descriptions is “percutaneous” and that’s why CPT 32556 and 32557 should be coded for a chest tube inserted through a percutaneous approach.

32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance

32557 with imaging guidance

With the above description for CPT code for Chest tube placement, it will very clear the main difference between them and that is the use of imaging guidance. So, check the presence or use of imaging guidance for coding chest tube placement cpt code.

List of Conditions treated with thoracostomy

Pneumothorax
Pleural Effusion
Empyema
Hemothorax

Related Procedure codes for Chest region

● 32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance

● 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance

The above procedure codes will be used when a needle or a catheter is used to gain access into the chest and drain the fluid, but a tube/catheter is not left in place at the end of the case. CPT code 32554 and 32555 are used to report such procedures.

The absence of an indwelling catheter, will take us to CPT codes 32554 and 32555 to report the procedure for drainage only. Like CPT codes 32556 and 32557, 32554 is for the drainage procedure without the use of radiology guidance while 32555 is for this same procedure with radiology guidance.

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CPT code for Chest tube Placement for Tunneled Catheter

As I mentioned previously, we have separate code for non-tunneled and tunneled catheter for chest tube placement. So, for placement of indwelling tunneled pleural catheter with cuff in chest we use CPT code 32550. So, be careful using this CPT code, which is supposed to be used only for tunneled placed chest tube catheters.

Tunneled pleural catheters also have a “cuff” that secures them underneath the skin so the mention of a “cuff”in the note is an additional clue you may be looking at a tunneled pleural catheter. Finally, Pleurx is a notable trade name for a tunneled pleural catheter so if your note indicates a Pleurx catheter insertion, you are looking at a tunneled pleural catheter.

Codes 32551, 32556, and 32557 are also used for pleural abscess or empyema drainage. These codes are for placement of indwelling catheters.

Report the appropriate E&M code for removal of an indwelling non-tunneled chest drainage catheter.

Report the appropriate E&M code for removal of fluid from the pleural space via a pre-existing drainage catheter.