How To Use CPT Code 32557

CPT 32557 describes the percutaneous drainage of the pleural space with the insertion of an indwelling catheter, using imaging guidance. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 32557?

CPT 32557 is used to describe the percutaneous drainage of the pleural space with the insertion of an indwelling catheter. This procedure is performed under imaging guidance, such as ultrasound or CT, to locate the fluid that needs to be drained from the chest. The provider makes a small incision and inserts a catheter into the chest to allow for drainage.

2. Official Description

The official description of CPT code 32557 is: ‘Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance.’

3. Procedure

1. The provider uses real-time imaging, such as ultrasound or CT, to locate the fluid in the pleural space that needs to be drained.
2. The provider preps the site and injects a local anesthetic into the area where the catheter will be inserted.
3. Under imaging guidance, the provider accesses the fluid collection using a needle and then passes a guidewire into the pleural space.
4. The provider replaces the needle with a dilator to create room for the catheter.
5. Once the dilator is removed, the provider inserts the indwelling catheter into the pleural space and secures it in place, often with stitches.
6. The external end of the catheter is connected to a suction drainage system.
7. The provider dresses the puncture site to ensure proper healing.

4. Qualifying circumstances

CPT 32557 is performed on patients who require drainage of fluid from the pleural space. The procedure is typically done for patients with conditions such as pleural effusion or pneumothorax. The provider must use imaging guidance, such as ultrasound or CT, to accurately locate the fluid collection. It is important to note that CPT 32557 should not be reported if the provider performs the procedure on the same side of the chest as other pleural drainage procedures (32554-32556) or certain imaging services (75989, 76942, 77002, 77012, 77021).

5. When to use CPT code 32557

CPT code 32557 should be used when the provider performs percutaneous drainage of the pleural space with the insertion of an indwelling catheter using imaging guidance. This code should not be used if the provider does not use imaging guidance or if a tunneled catheter with a cuff is inserted (use code 32550 for tunneled catheter placement).

6. Documentation requirements

To support a claim for CPT 32557, the provider must document the following information:

• Indication for the procedure, such as pleural effusion or pneumothorax
• Use of imaging guidance, including the type of imaging used
• Date of the procedure
• Specific details of the procedure, including the insertion technique and any complications encountered
• Type and size of the catheter inserted
• Connection of the catheter to a suction drainage system
• Dressing of the puncture site

7. Billing guidelines

When billing for CPT 32557, ensure that the procedure is performed with imaging guidance and that the catheter is inserted percutaneously. It is important to note that CPT 32557 should not be reported if the provider performs the procedure on the same side of the chest as other pleural drainage procedures (32554-32556) or certain imaging services (75989, 76942, 77002, 77012, 77021). If the procedure is performed bilaterally, appropriate modifiers should be used to indicate this.

8. Historical information

CPT 32557 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Examples

1. A patient with pleural effusion undergoes percutaneous drainage with the insertion of an indwelling catheter using ultrasound guidance.
2. A provider performs percutaneous drainage of a pneumothorax with the insertion of an indwelling catheter using CT guidance.
3. An individual with a large pleural fluid collection undergoes percutaneous drainage with the insertion of an indwelling catheter using ultrasound guidance.
4. A patient with recurrent pleural effusion undergoes percutaneous drainage with the insertion of an indwelling catheter using CT guidance.
5. A provider performs percutaneous drainage of a hemothorax with the insertion of an indwelling catheter using ultrasound guidance.
6. An individual with a complicated pleural effusion undergoes percutaneous drainage with the insertion of an indwelling catheter using CT guidance.
7. A patient with a traumatic pneumothorax undergoes percutaneous drainage with the insertion of an indwelling catheter using ultrasound guidance.
8. A provider performs percutaneous drainage of a pleural empyema with the insertion of an indwelling catheter using CT guidance.
9. An individual with a malignant pleural effusion undergoes percutaneous drainage with the insertion of an indwelling catheter using ultrasound guidance.
10. A patient with a chylothorax undergoes percutaneous drainage with the insertion of an indwelling catheter using CT guidance.