Coding Q&A: June 7, 2005

Q: A patient is seen in the emergency room (ER) where a thoracic physician places another suture in a previously placed chest tube. What ICD-9 and CPT codes should be used?

A: I refer you to the January 2002 CPT Assistant. Within this issue, a reader posed a question as to what CPT code to assign when a chest tube is placed in the operating room but no thoracentesis is performed. The American Medical Association's (AMA) guidance was to assign the unlisted CPT code, 32999. They go on to advise that if the chest tube was placed at the bedside, this would not constitute a separately payable procedure.

Applying the same coding guidance principles as outlined in the AMA's answer, I suggest not assigning a separate CPT code for a simple suture of the chest tube. Depending upon the extent of the surgeon's evaluation and management of the patient and the associated documentation, you may wish to consider assigning a low level E&M code, using the simple suture of the chest tube in the factoring in of the physician's medical decision making. As for the ICD-9 code, if this is an outpatient encounter, under HIPAA no ICD-9 code is required to be reported.

Glenn Krauss, RHIA, CCS, CCS-P

Q: Can you please clarify when a patient has a TURBT and has more than one lesion excised at the same episode of different sizes and different sites of the bladder, do you add the lesions or code each individual lesion by size with the code category of 52224, 52234 and 52235, 52240 and do we need modifier 59 to be added?

A: According to CPT Assistant, "When multiple bladder tumors are fulgurated or resected using a cystourethroscope, each tumor should be measured individually to determine the appropriate code category. The tumor sizes should not be added together for a cumulative total size. Each category code is reported once for single or multiple tumors within the category size range."

According to the CCI edits, when coding more than one size category, a modifier -59 is necessary.

Excerpt from CPT Assistant


When multiple bladder tumors are fulgurated or resected using a cystourethroscope, how is the size category determined? We have been advised to add all the tumor sizes together and report the total as small, medium or large. Is this correct?

AMA Comment

The tumor sizes should not be added together for a cumulative total size. Rather, each tumor should be measured individually to determine the appropriate category (e.g., small, medium, large). Code 52234, Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 to 2.0 cm), should be reported once for single or multiple tumors that individually measure 0.5-2.0 cm. Code 52235 should be reported once for medium (single or multiple) tumors that individually measure 2.0-5.0 cm. Tumors larger than 5.0 cm would be considered large tumors and would be reported using code 52240 one time.


Source: CPT Assistant 10/02

Angela Carmichael, RHIA, CCS, CCS-P

Q: Would you give an example of an operative report for CPT codes 23412, 23415, 23420?

A: I refer you to the February 2002 CPT Assistant, p. 11.

According to the AMA, "CPT codes 23410 and 23412 describe musculotendinous cuff (e.g., rotator cuff) repairs involving one or two tendons or major muscles of the rotator cuff. Code 23410 describes repair of an acute rupture and code 23412 describes repair of a chronic rupture.

Code 23420 describes a repair of a complete shoulder (rotator) cuff avulsion, referring to the repair of all three major muscles/tendons of the shoulder cuff."

With this in mind, you will need to consider whether the operative report and the H&P indicate the nature of the injury, acute or chronic.

Additionally, you will need to determine through thorough reading of the operative report whether the repair involves one or two tendons or major muscles of the rotator cuff or three major muscles/tendons of the shoulder cuff.

Glenn Krauss, RHIA, CCS, CCS-P

Q: What code(s) do you use for a patient that has esophagitis, gastritis and duodenitis? I know if you look up gastroesophagitis in the index, it gives you 530.19, but what code do you use if you also throw duodenitis into the mix, as there is also a code for gastroduodenitis? Does 530.19 cover all three?

A: When referencing gastritis, duodenitis and esophagitis without any further specification as to the type of each of these illnesses, take each one for exactly what is stated. If you look up gastritis without further specification you are lead to code 535.50, Unspecified gastritis and gastroduodenitis, without mention of hemorrhage. This code includes gastritis and duodenitis. For the esophagitis, do not assume that it is gastroesophagitis just because the two diseases are appearing at the same time. Code each separately. The code for esophagitis without any further specification is 530.10, Esophagitis, unspecified.

Hope Patterson, RHIT

The consultants, their companies and ADVANCE do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information.

Coding Clinic is published quarterly by the American Hospital Association
CPT is a registered trademark of the American Medical Association.

ICD Q & A Archives


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