Basics about Thoracentesis cpt code

Thoracentesis is a procedure performed to remove excess fluid (blood or pus) that has accumulated in the space between the outside of the lungs, the pleura, and the chest wall. There are two types of thoracentesis, therapeutic thoracentesis is performed to relieve the symptoms of fluid accumulation and diagnostic thoracentesis is performed to determine the cause of the fluid build-up. Procedure code  32554 and 32555 are used to report thoracentesis CPT code, either with or without imaging. 

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Thoracentesis CPT code 32554 and 32555 description

• 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;

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

• 32557, Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance.

From 2012, CPT code for chest drainage with a catheter (32551) was changed to an open procedure designation. . Code 32556 or 32557 are used for percutaneous placement of an indwelling pleural drainage tube. Codes 32555 and 32557 include the imaging guidance (fluoroscopic, ultrasound, CT, or MRI).

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Use of Guidance with Thoracentesis CPT code

Their are procedure codes like 32554 and 32556, which needs to be coded with guidance. Below are the four guidance codes supported or coded with these procedure codes.

Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation

Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)

Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation

Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation

Do not report 32554-32557 in conjunction with 32550, 32551, 76942 (ultrasound guidance), 77002 (fluoroscopy), 77012 (computed tomography), 77021 (magnetic resonance imaging), 75989 (fluoroscopy, computed tomography or ultrasound).

Do not report 32550 in conjunction with 32554, 32555, 32556, 32557 when performed on the same side of the chest

Do not report 33675-33677 in conjunction with 32100, 32551, 32554, 32555, 33210, 33681, 33684, 33688

Do not report 19260, 19271, 19272 in conjunction with 32100, 32503, 32504, 32551, 32554, 32555

Do not report 32554-32557 in conjunction with 75989, 76942, 77002, 77012, 77021

Do not report 77021 in conjunction with 10030, 19085, 19287, 32554, 32555, 32556, 32557, 0232T, 0481T

Do not report 32503, 32504 in conjunction with 19260, 19271, 19272, 32100, 32551, 32554, 32555

Sample Coded report Thoracentesis CPT code

REASON FOR STUDY:
Worsening Right sided pleural effusion. C56.2.

CLINICAL HISTORY:
History of advanced ovarian cancer with right-sided pleural effusion. The
patient has an elevated INR which precludes placement of a tunneled pleural
catheter at this time.

TECHNIQUE:
The study was performed in an ACR accredited facility. Medication
reconciliation form reviewed and any changes related to this procedure resolved.

REPORT:
The procedure of a thoracentesis was explained to the patient including the
risks, benefits, and possible complications. The patient was given the
opportunity to ask questions, wished to proceed, and signed the written
informed consent form. Using ultrasound guidance, a safe route of access was
identified into the right pleural space. The site was then prepped and draped
using maximal sterile barrier technique. 1% Lidocaine was used for local
anesthetic. With sonographic guidance, a 5-French Yueh needle catheter device
was placed with return of pleural fluid. The needle was placed into the
pleural space. Approximately 1.5 liter of sanguinous pleural fluid was removed.
The patient tolerated the procedure well without any immediate complications.

IMPRESSION:
1. Successful ultrasound-guided right thoracentesis with removal of
approximately 1.5 liter of sanguinous pleural fluid.

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

ICD 10 code – J90 Pleural effusion, not elsewhere classified