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Report chest tubes based on purpose of insertion

APCs Weekly Monitor, November 17, 2006

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Report chest tubes based on purpose of insertion

QUESTION: I have a question on how to code chest tube insertions for the facility side. What should I assign when a physician inserts 2-3 chest tubes? This particular scenario involves a trauma patient who undergoes other procedures in addition to the chest tube placement.

ANSWER: The question does not state why or how the physician places the tubes (i.e., for re-inflation, drainage, placed bilaterally, etc.). However, CPT Assistant, November 2003, Volume 13, Issue 11, p. 14, gives the following related guidance:

Question: A serious accident patient arrived in the emergency department with a hemothorax. The emergency department physician performed a tube thoracostomy for the hemothorax, inserting a tube for drainage. Would it be appropriate to report code 32002 for insertion of this tube, which will remain in place until the hemothorax has been resolved?

AMA Comment: It would not be appropriate to report code 32002, Thoracentesis with insertion of tube with or without water seal (eg, for pneumothorax), for the tube thoracostomy, as this code is intended to report the performance of a transient procedure. Code 32002 is reported for those occasions in which a patient is treated for abscess, hemothorax, or pneumothorax with a puncture of the pleural space, transient insertion of a catheter for aspiration of the compressing agent (blood, serum, air), and withdrawal of the catheter upon completion of the aspiration. Rather, for the procedure described in which a tube has been inserted into the pleural space for drainage, and stitched to the skin to remain in place for an extended period of drainage from the pleural space, it would be appropriate to report code 32020, Tube thoracostomy with or without water seal (e.g., for abscess, hemothorax, empyema).

32020 would be the appropriate code to use. If chest tubes are placed bilaterally, apply the code once with a
-50 modifier to indicate the bilateral location. If a chest tube is placed on only one side, use a -LT or -RT modifier as appropriate.

32020 includes the designation of "separate procedure" in its code descriptor. According to CPT Assistant, September 2000, Volume 10, Issue 9, p. 9 and p. 12, this designation indicates that a certain procedure or service may be:

• considered an integral component of another procedure/service;
• performed independently;
• unrelated; or
• distinct from other procedure(s)/service(s) provided at that time.

You cannot report codes designated as "separate procedures" when the procedure/service is performed as an integral component of another procedure/service.

As long as the chest tube placement was performed and meets the criteria to be considered as a "separate procedure," then it would be appropriate to assign 32020 for the procedure. If other procedures are performed at the same time, or if the chest tube placement is performed independently, the coder must assign modifier -59 to indicate that the procedure is indeed a separate procedure, according to CPT Manual guidelines.

You can report 32020 more than once and/or in conjunction with 32002 with the appropriate modifiers. For example, if the physician performed a thoracentesis first to release a hemothorax, and then inserted two tubes to promote drainage and keep the lungs inflated, you could report 32002 once and 32020 twice with the appropriate modifiers.

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