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exchange of chest tube

Kelly Posted Tue 21st of January, 2014 13:28:51 PM

pt w/ previously placed chest tube 32557, what is the code for chest tube exchange?

SuperCoder Answered Tue 21st of January, 2014 17:33:30 PM

Use code 32551 (Tube thoracostomy, includes water seal [e.g., for abscess, hemothorax, empyema], when performed [separate procedure]) .A chest tube insertion is in the pleural space between the pleural membranes that surround the lungs and the chest cavity.

Kelly Posted Thu 23rd of January, 2014 10:08:25 AM

I disagree w/ 32551 that is for tube thoracostomy "OPEN". This pt already had a pleural drainage tube placed (32557) this tube has now been "exchanged". What code can be used for the "exchange"

SuperCoder Answered Thu 23rd of January, 2014 12:16:44 PM

32557 represents “pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance.” There is no specific code for the removal of the catheter. It is included in the E/M service that may be reported on a subsequent day. There is a 0-day global period associated with this service, so E/M services provided on the same day are bundled into the procedure unless the E/M was performed for separately identifiable reasons. Code 32552 (removal of indwelling tunneled pleural catheter with cuff) should not be reported for the removal of these catheters; it is reserved for removal of the tunneled pleural catheter with cuff (associated with CPT 32550). Typically, these catheters are removed after the drainage, and not left in. You may need to clarify the “chest tube” that was initially placed, why it was exchanged, if it was reinserted at the same or separate incision, and the procedural details. Thanks.

Kelly Posted Thu 23rd of January, 2014 12:38:56 PM

the tube was exchanged because it had migrated out of the pleural space. A guidewire was placed thru the tube, the tube was removed and a new tube was placed over the wire and into the appropriate position in the pleural space.

Kelly Posted Fri 24th of January, 2014 07:11:37 AM

any suggestions for a code for exchanging the chest tube?

SuperCoder Answered Fri 24th of January, 2014 11:47:48 AM

A nontunneled chest tube may be placed for palliative care patients with a very poor prognosis and is not a candidate for other treatment options, but they are more likely to become dislodged or infected than tunneled chest tubes and are not recommended for long-term management. Replacement of the nontunneled catheter performed on a day other than initial insertion represents a coding challenge. If performed at an alternate site, CPT 32556 or 32557 could be reported. There is no CPT code to represent nontunneled pleural catheter replacement through the existing site. In this scenario, since a guidewire was placed through the tube, the tube was removed and a new tube was placed over the wire and into the appropriate position in the pleural space, 32556 or 32557 with modifier 52 to represent the reduced service of the incision not being required. An unlisted code may be another option, 32999. Be sure to check with the payer to determine which option is acceptable, if any.

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