Thoracentesis

Thoracentesis

Thoracentesis is the process of removing the excess plural fluid. Fluid accumulates in the pleural space, the area between the lung and the chest wall.

 Drainage of plural fluid can be performed using needle or catheter and the coding of the procedure is dependent on the technique.

 Below are the procedure codes for Thoracentesis,

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

Procedure Description:

The patient is placed in a seated position and slightly leaning forward with the arms resting on small table. the patient is appropriately prepped and anesthetized, the physician inserts a thin needle or catheter between the ribs into the space between the lungs and chest wall using imaging guidance,  He removes the fluid or blood from the chest cavity through the needle and sends it to the laboratory for investigation. After the provider drains the fluid, blood, or air, he close the site.

CPT 32555 includes imaging guidance, so it is  not separately reportable

CPT: 32557 - Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance

Procedure Description:

The physician uses imaging (ultrasound or CT) to locate the fluid to be drained from the chest. He preps the site and injects a local anesthetic into the catheter insertion area. He use a needle to access the fluid collection under imaging guidance and then pass a guidewire into the pleural space. The physician replace the needle with a dilator to create room for the catheter. He then replaces the dilator with the catheter. Once he properly positions the catheter in the space, he secures the tube in place such as by stitches. He connects the external end of the tube to a suction drainage system. He dresses the puncture site.
 

If the provider does not use imaging guidance, then assign 32556.

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

Procedure Description:

The patient is prepped and anesthetic, He makes a small incision between the ribs to pass the catheter through the skin. He then passes the catheter into the chest without imaging guidance. He secures the tube in place such as by stitches. He connects the external end of the tube to a suction drainage system. He dresses the puncture site.

For insertion of indwelling tunneled pleural catheter with cuff, use 32550

CPT: 32550 - Insertion of indwelling tunneled pleural catheter with cuff 

Procedure Description:

The patient is appropriately prepped and anesthetized, the physician makes an incision in the chest and inserts a hollow needle into the pleural space. he inserts a guide wire through the needle. he then removes the needle and leaves the guide wire in place. The physician then makes a second incision and passes a tunneling device with the catheter subcutaneously, from the second incision until it exits through the original incision site. he advances the catheter using the tunneling device until the cuff is buried just under the second incision. The physician then feeds a dilator over the guide wire into the pleural space, inserts the catheter, and secures it. he leaves the chest tube in place with one end exiting the body for connection to a collection container. The chest tube helps re–expand the lungs if necessary and allows for drainage of air, blood, or fluid. The physician closes the original upper incision with staples or stitches

If imaging guidance is used, then assign 75989

CPT: 75989 - Radiological guidance (Eg, fluoroscopy, ultrasound, or CT), for percutaneous drainage  with placement of catheter, radiological supervision and interpretation

Use CPT 32552 for removal of an indwelling tunneled pleural catheter with cuff.

CPT: 32552 - Removal of indwelling tunneled pleural catheter with cuff 

Procedure Description:
The provider  uses local anesthetic. He makes an incision into the skin over the catheter, frees the catheter from the skin, and gently pulls back the catheter out of the pleural space. The physician cleans the incision site with antibiotics and applies the dressing

CPT: 32551 - Non-tunneled indwelling chest tube without cuff for abscess or effusion

Procedure Description:

The patient is appropriately prepped and anesthetized, the physician uses a trocar to make an incision on the chest wall near the fifth intercostal space and enters the pleural cavity. The physician then inserts a hollow plastic tube between the ribs and into the chest to draw out fluid or air from and around the lungs. The physician sutures the skin to keep the tube in place. The physician may attach the free end to an underwater seal, which allows drainage of fluid and air from the chest. The provider uses this technique in cases of pneumothorax and pleural effusion.

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