Part B Insider (Multispecialty) Coding Alert

Plus: Expansion of lung biopsy section could please pulmonology coders

Have you been stymied in the past when trying to figure out what constitutes a "limited" thoracotomy for biopsy? You'll wonder no more, now that CPT 2012 scraps the previous ambiguous code and brings in a whole new section that clarifies this issue. We've got a look at these changes and more, so read on for tips on how to code your claims in 2012.

Pulmonology Codes Get Face Lift

Practices that specialize in pulmonology will be pleased to see a long-overdue update to the lung biopsy section of CPT®. Previous "catch all" code 32095 (Thoracotomy, limited, for biopsy of lung or pleura) has been deleted, and will be replaced with the following more specific codes that describe the biopsy type and method:

• 32096 -- Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral
• 32097 -- Thoractomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral
• 32098 -- Thoractomy, with biopsy(ies) of pleura

Likewise, CPT continued its adjustment of the pulmonology codes by deleting 32500 (Removal of lung, other than total pneumonectomy; wedge resection, single or multiple) and CPT 2012 offers up the following three new codes in its place:

• 32505 -- Thoractomy; with therapeutic wedge resection (eg, mass, nodule), initial
• +32506 -- ...with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)
• +32507 -- ...with diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure)

Pacemaker Changes Rock Cardiology Coding

Cardiologists often have to implant, remove, and replace pacemakers, and most coders know that the types of devices used can vary widely. CPT acknowledges that fact with several changes that can help you specify which type of device your physician uses. You'll find the pacemaker removal section changed to reflect the following adjustments.

Code 33233 has been revised, and now says, "Removal of permanent pacemaker pulse generator only." In addition, the following codes will describe pacemaker replacements:

• 33227 -- Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system
• 33228 --...dual lead system
• 33229 --...multiple lead system

Curious: Yes, your eyes haven't deceived you--the new codes 33227-33229 do follow 33233 in CPT, despite the fact that they numerically should come before it. These codes were introduced out of sequence, CPT acknowledges.

Likewise, the pacing cardioverter-defibrillator insertion category has changed, with 33240 now describing "Insertion of pacing cardioverter-defibrillator pulse generator only; with existing single lead." In addition, you'll find the following two codes effective Jan. 1 to expand that section:

• 33230 -- ...with existing dual leads
• 33231 --...with existing multiple leads