Different calendar dates matter, but multiple instillations the same day do not.
Question: My pulmonologist inserted a chest tube and then instilled a fibrinolytic agent to break up multiloculations to free up an entrapped lung. Usually, I use 32560 for this procedure, which is for pleurodesis, not fibrinolysis. What code should I use for fibrinolytic agent instillation?
Answer: As of Jan. 1, you should be using one of two new fibrinolytic agent instillation codes depending on the treatment day:
• For instillation on the initial day, use 32561 (Instillation[ s], via chest tube/catheter, agent for fibrinolysis [e.g., fibrinolytic agent for breakup of multiloculated effusion]; initial day).
• If the pulmonologist instills the fibrinolytic agent on a subsequent day, assign 32562 (… subsequent day).
Rule: Always report each day’s code only once. Instillation, however, may occur multiple times per day over the course of several days. Currently, you have to code fibrinolysis as an unlisted procedure using 32999 (Unlisted procedure, lungs and pleura).
You are correct to code for instillation of an agent for pleurodesis with 32560. In 2009, the code read “Chemical pleurodesis [e.g., for recurrent or persistent pneumothorax].” Now the code specifies agent instillation through a chest tube or catheter and gives an example agent (talc): “Instillation, via chest tube/catheter, agent for pleurodesis (e.g., talc for recurrent or persistent pneumothorax).”
CPT 2010 further revised this code to remind you when it is appropriate to also code the chest tube insertion with 32551 (Tube thoracostomy, includes water seal [e.g., for abscess, hemothorax, empyema], when performed [separate procedure]).
Related articles:
- Radiology Coding: CPT 2010 Breathes New Life Into Your Respiratory CodingMaster 32561’s guidelines to prevent a major units gaffe. Flip…
- Signs & Symptoms Coding Coach: Chest Pain 786.50-786.59: One of the most common symptoms that cardiovascular…
- PFS Treasure Chest: Read Medicare’s MindIt seems like dry reading, but the physician fee schedule…
