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Malignant Pleural Effusions^*

Management Options With Consideration of Coding, Billing, and a Decision Approach

^* From the Interventional Pulmonary Program (Dr. Haas), Jefferson Medical College of Thomas Jefferson University, Pulmonary and Critical Care Medicine; and Interventional Pulmonary Program (Drs. Sterman and Musani), Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.

Correspondence to: Andrew R. Haas, MD, PhD, Assistant Professor of Medicine, Director, Interventional Pulmonary Program, Jefferson Medical College of Thomas Jefferson University, Pulmonary and Critical Care Medicine, 834 Walnut St, Sixth Floor, Philadelphia, PA 19107; e-mail: andrew.haas{at}jefferson.edu

Abstract

Malignant pleural effusions (MPEs) are a troublesome and debilitating complication of advanced malignancies, with > 150,000 cases in the United States each year. The standard management approach begins with a diagnostic and/or therapeutic thoracentesis. Should the MPE recur, a more definitive management strategy is often undertaken with several approaches available to the chest physician or surgeon. These options include repeat thoracentesis, tube thoracostomy with chemical pleurodesis, placement of an indwelling cuffed, tunneled pleural catheter with or without pleurodesis, or medical pleuroscopy or video-assisted thoracoscopic surgery with pleurodesis. Each approach has unique advantages, disadvantages, and likelihood of successful symptom relief and pleurodesis. This article will provide a general review of MPE management strategies including information concerning coding, billing, documentation, and a decision approach among these various methods.

Key Words: malignant pleural effusion • pleural catheter • pleurodesis • practice management • thoracoscopy