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Official Description

Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 32556 involves the percutaneous drainage of the pleural space through the insertion of an indwelling catheter, specifically performed without the use of imaging guidance. This procedure is commonly utilized to alleviate conditions where there is an accumulation of air (pneumothorax) or fluid (pleural effusion) within the chest cavity, which can compromise respiratory function. The process begins with the physician inserting an introducer needle into the pleural cavity, allowing access for further instrumentation. Following this, an introducer wire is threaded through the needle, which is subsequently removed to facilitate the placement of a dilator. The dilator is advanced into the pleural cavity to enlarge the puncture site, making it easier to insert the catheter. Once the dilator is removed, the catheter is placed over the wire, and the wire is taken out. In some cases, a small incision may be made at the 4th or 5th intercostal space to access the pleura directly. A Kelly clamp may be used to create a pneumothorax, allowing for the insertion of the chest tube. After placement, the catheter or tube is secured with sutures and connected to a suction unit, which may include a water seal chamber to prevent air from re-entering the pleural space. It is important to note that if imaging guidance such as ultrasound, fluoroscopy, or CT is utilized during the procedure, CPT® Code 32557 should be reported instead.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 32556 is indicated for the following conditions:

  • Pneumothorax - The presence of air in the pleural space, which can lead to lung collapse and respiratory distress.
  • Pleural effusion - The accumulation of fluid in the pleural cavity, which can cause difficulty in breathing and chest discomfort.
  • Empyema - A collection of pus in the pleural space, often resulting from infection, necessitating drainage to alleviate symptoms and prevent further complications.

2. Procedure

The procedure for CPT® Code 32556 involves several key steps to ensure effective pleural drainage:

  • Step 1: Preparation - The patient is positioned appropriately, and the area of the chest where the procedure will be performed is cleaned and sterilized to minimize the risk of infection.
  • Step 2: Needle Insertion - An introducer needle is carefully inserted into the pleural cavity, allowing access for further instrumentation. This step is critical for establishing a pathway into the pleural space.
  • Step 3: Wire Placement - An introducer wire is threaded through the needle, which is then removed. This wire serves as a guide for the subsequent placement of the dilator and catheter.
  • Step 4: Dilation - A dilator is placed over the wire and advanced into the pleural cavity. This action dilates the puncture site, facilitating the insertion of the catheter.
  • Step 5: Catheter Insertion - After the dilator is removed, a catheter is inserted over the wire into the pleural space. The wire is then withdrawn, leaving the catheter in place for drainage.
  • Step 6: Incision (if necessary) - In some cases, a small incision may be made at the 4th or 5th intercostal space to access the pleura directly. A Kelly clamp may be used to create a pneumothorax, allowing for the insertion of the chest tube.
  • Step 7: Securing the Catheter - The catheter or tube is secured with sutures to ensure it remains in place and is connected to a suction unit. This unit may include a water seal chamber to prevent air from re-entering the pleural cavity.

3. Post-Procedure

After the completion of the procedure, the patient is monitored for any complications, such as bleeding or infection. The catheter remains in place for ongoing drainage of air or fluid, and the patient may require follow-up imaging to assess the effectiveness of the drainage. The healthcare team will provide instructions on care for the insertion site and any necessary follow-up appointments to evaluate the patient's recovery and the need for further intervention.

Short Descr INSERT CATH PLEURA W/O IMAGE
Medium Descr PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
Long Descr Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P6C - Minor procedures - other (Medicare fee schedule)
MUE 2
CCS Clinical Classification 39 - Incision of pleura, thoracentesis, chest drainage
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
81 Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number.
AG Primary physician
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
ET Emergency services
FS Split (or shared) evaluation and management visit
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
SA Nurse practitioner rendering service in collaboration with a physician
ST Related to trauma or injury
X3 Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XP Separate practitioner, a service that is distinct because it was performed by a different practitioner
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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Notes
2017-01-01 Note AMA errata dated 2017-08-02 Revised reference to correctly reflect with & without imaging codes: without imaging - 32556; with imaging - 32557.
2013-01-01 Added Added
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