Advances in Pleural Disease Management Including Updated Procedural Coding

  • Andrew R. Haas
    Correspondence
    Correspondence to: Andrew R. Haas, MD, PhD, FCCP, Section of Interventional Pulmonary and Thoracic Oncology, University of Pennsylvania Medical Center, 823 W Gates Bldg, 3600 Spruce St, Philadelphia, PA 19104
    Affiliations
    Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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  • Daniel H. Sterman
    Affiliations
    Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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      Over 1.5 million pleural effusions occur in the United States every year as a consequence of a variety of inflammatory, infectious, and malignant conditions. Although rarely fatal in isolation, pleural effusions are often a marker of a serious underlying medical condition and contribute to significant patient morbidity, quality-of-life reduction, and mortality. Pleural effusion management centers on pleural fluid drainage to relieve symptoms and to investigate pleural fluid accumulation etiology. Many recent studies have demonstrated important advances in pleural disease management approaches for a variety of pleural fluid etiologies, including malignant pleural effusion, complicated parapneumonic effusion and empyema, and chest tube size. The last decade has seen greater implementation of real-time imaging assistance for pleural effusion management and increasing use of smaller bore percutaneous chest tubes. This article will briefly review recent pleural effusion management literature and update the latest changes in common procedural terminology billing codes as reflected in the changing landscape of imaging use and percutaneous approaches to pleural disease management.

      Abbreviations:

      CPT ( common procedural terminology), DNase ( deoxyribonuclease), MIST ( Multicenter Intrapleural Sepsis Trial), MPE ( malignant pleural effusion), RVU ( relative value unit), tPA ( tissue plasminogen activator), TPC ( tunneled pleural catheter)
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