When someone says chest tube insertion, most coders immediately think of CPT 32551 as the code to represent this procedure. While CPT 32551 is certainly one valid code for a chest tube insertion into the pleura, it is not the only code that can describe this procedure. To ensure we select the correct CPT code, the main key we need to look for in the procedure report is the approach to the procedure. A chest tube may be inserted through an open approach or a percutaneous approach.
An open approach requires an incision in the chest wall to allow the tube to be passed into the pleura. If an open incision is made in the chest wall to place the chest tube, CPT 32551 is appropriate. The CPT description includes the words “tube thoracostomy.” This phrase, when we break it down, means that a tube is creating a continual opening from the chest to the outside of the body (since thora- refers to the chest/thorax and ostomy means “to create an opening”). The other important word in the CPT description is “open” and that’s why CPT 32551 should only be coded when a chest tube is inserted through an open approach.
A chest tube may also be inserted through a percutaneous approach. This approach involves making a small puncture in the chest wall. Fluid is then drained from the pleura using a needle or catheter. A catheter (aka a tube) is then left in place to allow for continued drainage. CPT 32556 and 32557 are appropriate codes to report a percutaneous chest tube insertion. The difference between CPT 32556 and 32557 is whether radiology guidance is used. If the documentation supports ultrasound, fluoroscopy, CT, or MRI used to gain visualization of the chest and guide the placement of the needle/catheter, report CPT 32557. If these details are not mentioned in the note, report CPT 32556. If we look at the CPT description for these codes we see the phrase “with insertion of indwelling catheter” which is referencing the fact that the catheter is left in place at the end of the drainage procedure. The other important word in the CPT descriptions is “percutaneous” and that’s why CPT 32556 and 32557 should be coded for a chest tube inserted through a percutaneous approach.
Coding tip: There are also two additional codes for drainage of the pleura available (CPT codes 32554 and 32555). In these two procedures, a percutaneous approach is used and a needle or a catheter is used to gain access into the chest and drain the fluid, but a tube/catheter is not left in place at the end of the case. The lack of an indwelling catheter at the end of the case would take us back to CPT codes 32554 and 32555 to report the procedure for drainage only. Like CPT codes 32556 and 32557, 32554 is for the drainage procedure without the use of radiology guidance while 32555 is for this same procedure with radiology guidance.
Finally, we have one additional code for a pleural catheter insertion that is worth mentioning. CPT 32550 is for a tunneled pleural catheter insertion. This code also has a percutaneous approach, but instead of one simple percutaneous stick, an initial percutaneous stick is made, but then a “subcutaneous tunnel” is created in the chest wall. The catheter is placed through the initial stick and then threaded through the tunnel and to a separate exit site. The “tunneling” described by this code sets it apart from the procedures reported with CPT codes 32554-32557. Tunneled pleural catheters also have a “cuff” that secures them underneath the skin so the mention of a “cuff”in the note is an additional clue you may be looking at a tunneled pleural catheter. Finally, Pleurx is a notable trade name for a tunneled pleural catheter so if your note indicates a Pleurx catheter insertion, you are looking at a tunneled pleural catheter.
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