Thoracostomy FAQ

CPT does not provide specific documentation requirements for a Thoracostomy.

The medical record should clearly indicate that the procedure was performed, the technique utilized (needle, percutaneous, or open) and identify the performing clinician.

For needle decompression or thoracentesis:

• 32554 - Thoracentesis, needle  or catheter, aspiration of the pleural space, without imaging guidance
• 32555 - Thoracentesis, needle or catheter, aspiration of the pleural space, with imaging guidance

For percutaneous placement of an indwelling catheter (pigtail placement):

• 32556 – Pleural drainage, percutaneous, with insertion of indwelling catheter, without imaging guidance
• 32557 – Pleural drainage, percutaneous, with insertion of indwelling catheter, with imaging guidance

For open tube thoracostomy (surgical chest tube placement):

• 32551 – Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure)

As with all ultrasound codes, the CPT code descriptor requires permanent recording of the ultrasound image to report any “with imaging guidance” codes. If no permanent images are saved, the coder must assign the thoracentesis code that designates “without imaging guidance” (32554, 32556). You cannot separately report ultrasonic guidance code 76942, Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation with any of the “with imaging guidance” codes.

If thoracostomy is performed bilaterally, then the procedure is billed twice, either by appending the modifier -50 or by including the code twice with modifiers for laterality (RT, LT). Payer preference dictates which format is chosen.

If two thoracostomy tubes or catheters are required on the same side, then the medical necessity for the second device should be documented and the procedure can be coded twice and appended with the modifier to indicate a distinct procedure was performed (typically modifier -59). This only applies if the two devices are required simultaneously (e.g. a loculated effusion or thoracic lavage in hypothermia). If a needle decompression is converted to a percutaneous or open chest tube on the same side and during the same session, then only the definitive procedure is billed.

Reimbursement patterns vary depending on the payer. Additionally, some groups may choose not to code failed procedures for various reasons. If a group decides to code and bill for a failed procedure, a modifier is typically applied.

For example, if the procedure is partially reduced or not completed at the discretion of the physician or qualified health care professional, it may be reported with modifier 52 (“Reduced Services”). If the procedure is interrupted due to extenuating circumstances or a threat to the patient's well-being, it may be reported with modifier 53 (“Discontinued Procedure”), according to CPT guidelines. In both cases, there should be clear documentation about what portions of the procedure were completed and why the procedure was discontinued.

It’s important to note that both modifiers 52 and 53 usually result in reduced payment from payers.

No, thoracentesis and thoracostomy are separately billable. Do not include the time spent performing these procedures in the total critical care time.