If you’ve ever paused while coding a pleural procedure and thought, “Is this thoracentesis, pleural drainage, or a chest tube?” — you’re not alone. CPT codes 32551 through 32557 are some of the most commonly confused codes in medical coding.
They all involve the pleural space, the documentation can sound similar, and small details make a big difference. The good news? Once you know what to look for, these codes become much easier to assign correctly.
Three Questions That Make These Codes Click
Before choosing a CPT code, ask yourself:
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Was the procedure open or percutaneous?
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Was a catheter left in place, or was it needle-only?
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Was imaging guidance used and documented?
Answering these three questions will usually lead you straight to the correct code — regardless of the diagnosis.
CPT 32551 — Open Chest Tube Placement
CPT 32551 is used for open chest tube (tube thoracostomy) placement. This is a surgical procedure involving a chest wall incision and blunt or sharp dissection to place a large-bore tube into the pleural space.
You’ll typically see this in:
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Pneumothorax
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Hemothorax
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Trauma cases
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Empyema
If imaging is used during the procedure, it is bundled and not reported separately.
CPT 32554 and 32555 — Thoracentesis
Thoracentesis is needle aspiration only. The key thing to remember is simple: no catheter is left behind.
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32554 — Thoracentesis without imaging guidance
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32555 — Thoracentesis with imaging guidance (usually ultrasound, bundled)
If the needle comes out and nothing stays in, you’re looking at a thoracentesis code.
CPT 32556 and 32557 — Percutaneous Pleural Drainage
These codes apply when the physician places an indwelling pleural drainage catheter, commonly a pigtail catheter, for ongoing drainage.
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32556 — Percutaneous pleural drainage without imaging guidance
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32557 — Percutaneous pleural drainage with imaging guidance (bundled)
The deciding factor here is the catheter — not how much fluid was removed or why the procedure was done.
A Very Common Coding Scenario
Here’s one that trips up many coders:
A procedure starts as a thoracentesis (32555), but during the procedure, the physician decides to leave the catheter in place.
In this situation, do not code both procedures. You should report only the more comprehensive service:
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32557 if imaging guidance was used
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32556 if imaging guidance was not used
Thoracentesis is considered inherent to catheter placement when performed during the same session.
One More Important Thing: Finger Chest Decompression
In trauma and emergency settings, documentation may mention finger thoracostomy or finger chest decompression, especially for suspected tension pneumothorax.
Here’s the key coding rule:
👉 Finger chest decompression does NOT have a CPT code.
This is a temporary, life-saving maneuver, often performed before a formal chest tube is placed.
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If only finger decompression is performed → no CPT code
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If a formal chest tube is placed afterward → report CPT 32551
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Do not code finger decompression as thoracentesis or pleural drainage if no needle/catheter used.
No tube, no catheter, no CPT.
Quick Cheat Sheet
| CPT Code | Procedure | Catheter Left In? | Imaging Used? |
|---|---|---|---|
| 32551 | Open chest tube | Yes | Bundled |
| 32554 | Thoracentesis | No | No |
| 32555 | Thoracentesis | No | Yes |
| 32556 | Percutaneous drainage | Yes | No |
| 32557 | Percutaneous drainage | Yes | Yes |
Final Thoughts
When coding pleural procedures, don’t get distracted by the diagnosis or how urgent the situation was. Focus on how the procedure was performed, whether a catheter was left in place, and whether imaging guidance was used.
Once you train your eye to look for those details in the documentation, CPT codes 32551–32557 stop being confusing — and start making sense.
