Knowledge Base Category -

Clarification of Thoracentesis CPT Codes 32421 and 32422

Question:

When reporting CPT code 32422 “thoracentesis with insertion of tube including water seal when performed”, is this referring to a chest tube that is left in place after the thoracentesis is completed?

Answer:

The key to answering this question is to look back at the November 2003 CPT Assistant addressing coding guidelines for CPT codes 32000 and 32002. (In 2008, these CPT codes were revised to 32421 and 32422, respectively. The code descriptions remained the same, but the codes were renumbered in CPT.)

In the article, it is noted that CPT code 32002 (now 32422) “thoracentesis with insertion of tube including water seal when performed” represents a procedure where tube is removed at the end of the thoracentesis.

Therefore, 32422 would not be appropriate for reporting a thoracentesis where a chest tube was left in after the procedure. This information is supported by a 2009 SIR article and a 2007 article from Chest Journal.

In most of the procedure reports seen by MMP, Inc., the physician indicates a thoracentesis was performed with drainage occurring through a “catheter” – with the catheter removed at the end of the procedure. CPT code 32422 is the appropriate CPT code for this procedure.

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Question:

When should CPT code 32421 be used (thoracentesis, puncture of pleural cavity for aspiration)?

Answer:

CPT code 32421 describes a procedure where a needle is inserted and a smaller amount of fluid is aspirated, usually for diagnostic purposes (whereas CPT code 32422 is for therapeutic purposes). Again, in 32421, the needle is removed at the end of the aspiration procedure. SIR 2009 indicates the difference between CPT code 32421 and 32422 is -32421 is thoracentesis performed with a needle, usually for diagnostic purposes to obtain pleural fluid for analysis and diagnosis

-32422 is thoracentesis performed via catheter, usually for therapeutic purposes of relieving a pleural effusion. Pleural fluid may also be submitted for analysis.

Self-Administered Drugs Used as Supplies

Question:
Is it ever appropriate to bill for self-administered drugs (SADs) as covered services?

Answer:
Yes, when these drugs function as supplies. This occurs when the drugs provided are an integral component of a procedure or are directly related to it, i.e., when they facilitate the performance of or recovery from a particular procedure

For example, drugs used as supplies would include:

• sedatives administered to prepare a patient for a procedure
• antibiotic ointment placed on a wound/incision at the completion of a procedure.

See the July 2012 OPPS update (MLN Matters MM7847) for more examples of when self-administered drugs would and would not be separately billable to Medicare. Drugs paid as supplies should be reported under the revenue code associated with the cost center under which the hospital accumulates the costs for the drugs (most hospitals use revenue code 0250).