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  • Posted by 19770, 2 years ago. There are 3 posts. The latest reply is from 19770.
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  1. Chest tube was placed in the ER. Later in the OR the surgeon performs splenectomy and removes the tube. Should I use an unlisted code for the removal, since it is removed by another provider than who put it in?
    thanks

  2. Good question Maarit.
    If the chest-tube removal falls within the global period of a surgery (90 days) performed by the same physician, and does not require a return to the operating room, it is included in the surgical fee. If it does not fall within a global period and requires an incision, an unlisted procedure code (39499 unlisted procedure, mediastinum) should be reported. Documentation should be submitted with the code detailing what was performed. If the removal is non-incision, this service is included in the E/M codes reported by the physician for that day.
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    CPT 2010 assigned a new code for chest tube removal 32552, but this is not applicable for normal chest tube removal. The procedure takes just a few seconds, and payers include your reimbursement as part of any other services provided on that date, such as E/M or in this case, placement of the new tube.
    You would only use code 32552 (Removal of indwelling tunneled pleural catheter with cuff) if the surgeon removes a special kind of chest tube that is tunneled under the skin. If the physician removes a tunneled catheter and replaces it with a new tunneled catheter, both 32552 for the removal and 32550 (Insertion of indwelling tunneled pleural catheter with cuff) for the placement should be reported.
    If the physician removes a tunneled catheter and replaces it in the same location with a non-tunneled chest tube (32551, Tube thoracostomy, includes water seal [e.g., for abscess, hemothorax, empyema], when performed [separate procedure]), you can’t bill for both services. CPT “separate procedure” designation means that 32551 is an “integral component” of other procedures at that site.
    Exception: If the physician removes a tunneled pleural catheter and places a normal chest tube at a different location (such as the other side of the chest), you could bill both codes by appending modifier 59 (Distinct procedural service) to 32551.
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    Hope this helps you a lot.

  3. Thank you!

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