Pulmonology Coding Alert

Watch out for changes to tobacco counseling sessions, too.

Your reporting for spirometry and sleep study interpretations may need adjusting, thanks to the most recent round of Correct Coding Initiative (CCI) edits. Version 18.2 brings the following changes to some spirometry and sleep study bundles.

CPT® codes 95800 (Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis [e.g., by airflow or peripheral arterial tone], and sleep time) -95811 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist) encompasses the entire range of sleep study codes (both attended and unattended sleep studies and polysomnography) that are performed by your pulmonologist. Your pulmonologist may perform these sleep studies by measuring various parameters through electrocardiography.

As of July 1, CCI added these Category III codes to the other types of ECG monitoring considered as components of 95800-95811:

• 0295T (External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation)
• 0296T (External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; recording [includes connection and initial recording])
• 0297T (External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; scanning analysis with report)
• 0298T (External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; review and interpretation)

Note: ECG information obtained by any method is considered integral to sleep studies. These above mentioned codes for external electrocardiographic recordings are also column 2 codes for unattended home sleep study codes G0398 (Home sleep study test [HST] with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation), G0399 (Home sleep test [HST] with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation) and G0400 (Home sleep test [HST] with type IV portable monitor, unattended; minimum of 3 channels) that you will report when your pulmonologist will perform interpretations for sleep studies for Medicare patients. This means that you cannot report these category III codes separately when you report home sleep studies.

Watch Out For These Spirometry Bundles

As indicated in V18.2 of the CCI edits, the code ranges for spirometry (94010, 94011 and 94014) are going to include these measurements that your pulmonologist might record during the procedure and should not be reported separately:

• 0243T (Intermittent measurement of wheeze rate for bronchodilator or bronchial-challenge diagnostic evaluation[s], with interpretation and report)
• 0244T (Continuous measurement of wheeze rate during treatment assessment or during sleep for documentation of nocturnal wheeze and cough for diagnostic evaluation 3 to 24 hours, with interpretation and report).

"Be sure to review the edits, as these codes are considered mutually exclusive to some procedures (unlikely to be performed on the same date), components of other procedures, and comprehensive to yet another set of procedures," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania, Department of Medicine in Philadelphia.

Note This Interesting Code Bundle

If your physician provides counseling for tobacco cessation as well as screening the patient for alcohol misuse, then you should be careful about reporting the two sessions together as version 18.2 of the CCI does not allow you to report these codes together.

The codes for screening for alcohol misuse are column 2 codes for tobacco cessation counseling and should not be reported together unless a suitable modifier is attached.

What it means: If you are reporting 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes) for tobacco cessation counseling sessions, you cannot report G0442 (Annual alcohol misuse screening, 15 minutes) or G0443 (Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes) unless you report it with a suitable modifier such as 59 (Distinct procedural service), when appropriate.

Reminder: "The intent of NCCI is to promote national correct coding methodologies and prevent improper payment when incorrect code combinations are reported. Unbundling should only occur when permitted (code pairs that have a modifier indicator of "1" (The modifiers associated with NCCI are allowed with this code pair when appropriate)," says Pohlig. "Documentation should reflect the circumstances involved in overriding the edit. Expect a request for documentation from the payer to ensure the appropriateness of separate payment."

Learn more: For the complete set of the version 18.2 of the CCI edits, visit www.cms.gov/NationalCorrectCodInitEd -- or search for bundles affecting individual codes by using the CCI edits checker at https://www.aapc.com/codes/.