We have a patient who had a multiloculated right empyema with pleural gas fluid levels at the apex. The radiologist placed two 14 French drains—one between the seventh and eighth intercostal space and one at the sixth and seventh intercostals space. An Oasis water-seal device was connected to the tubes at -20 cm H2O. The procedure was performed under ultrasound guidance.
Do we code this as a thoracentesis w/ tube insertion (32557)? Do we assign the code once or twice, or is there another code we should be using since he put the drain to water seal?
You would submit the following CPT code twice—for each area separately treated:
32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance
This is confirmed in Clinical Examples in Radiology, Winter 2013, which states that a code would be assigned for each catheter placed regardless of whether it was one or two collections.
As with all claims, you may have state-specific rules that need to be followed regarding modifier assignment, so make sure that you adhere to the recommendations from your payer.