Pulmonology Coding Alert

No fooling: The new Correct Coding Initiative (CCI) went in effect April 1, and it contains bundles for continuous inhalation treatment -- as well as one for pediatric apnea monitoring and some new facility E/M edits. Read on to find out what the experts say about when you can break these bundles -- and when you need to let them be.

Beware of one new bundle when coding inhalation treatments. You should not report an individual inhalation treatment, such as with a nebulizer, in addition to continuous inhalation treatment

CCI makes inhalation treatment code 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) a component of the more extensive code 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour).

Warning: The edits do not allow you to override the bundle under any circumstances. Choose the correct code based on time following these guidelines:

• Use 94640 for intermittent inhalation treatment of less than 1 hour.

• Restrict 94644 only to procedures lasting at least 60 minutes, according to Medical Learning Inc.'s respiratory compliance experts.

How many medicine codes should you report if your pulmonologist interprets results from an electrocardiogram (ECG) and pediatric home apnea monitoring recording? The answer is one, CCI 14.1 says. Pediatric home apnea monitoring (94774-94777) also includes a related ECG (93000-93010).

Code 94774-94777 bundles also apply to telephonic transmission (93012-93014), ECG rhythm strips (93040-93042), pediatric pneumogram (94772), and sleep testing (95805).

The edits bring CMS in line with CPT. The AMA's CPT Changes 2007: An Insider's View states that "94774 includes attaching the monitor, downloading the data, reviewing and interpreting the data by a physician, and preparation of the report," says Jill M. Young, CPC-ED, CPC-IM, president of Young Medical Consulting LLC in East Lansing, Mich. "Any 'downloading of data' whether on-site or an electronic transmission would be included."

The edits have a 1 indicator, meaning if the physician orders the monitoring and the cardiovascular/pulmonary testing at different sessions, you can report the test code with modifier 59 (Distinct procedural service).