Pulmonology Coding Alert

Hint: Check modifier indicators to know when a recorded parameter can be unbundled.

As you’re getting accustomed to using new polysomnography codes (95782 and 95783) for a child aged below six years, you’ll need to factor in how to report these codes when your pulmonologist also performs a same session sleep study or a pulmonary diagnostic procedure. See the advice that follows on polysomnography bundling in the most recent Correct Coding Initiative (CCI) edits.

Watch for Sleep Study Code Pairings

When your pulmonologist performs polysomnography studies for a child aged less than six years, you cannot report any other sleep studies, CCI edits version 19.0 indicate. Accordingly, you cannot report these below mentioned codes with 95782 (Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist) or 95783 (…with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist):

95803 (Actigraphy testing, recording, analysis, interpretation, and report [minimum of 72 hours to 14 consecutive days of recording])

95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort [e.g., thoracoabdominal movement])

95807 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist)

Reminder: The CCI edits state that the polysomnography and sleep study code bundles carry the modifier indicator ‘0.’. "If two codes are bundled by CCI edits with the modifier indicator "0," then those codes can never be reported together," says Alan L. Plummer, MD, Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta. "You can bill one or the other, but not both."

Apply Brakes Before Reporting Concurrent Pulmonary Diagnostic Procedures

If your pulmonologist performs a polysomnography for a child younger than six years, you will not be allowed to report any concurrently performed pulmonary diagnostic procedures, as these are bundled as mentioned in the new CCI edits. So, you will only report 95782 or 95783 when your pulmonologist performs these procedures:

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)

94200 (Maximum breathing capacity, maximal voluntary ventilation)

94620 (Pulmonary stress testing; simple [e.g., 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry])

94660 (Continuous positive airway pressure ventilation [CPAP], initiation and management)

94681 (Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted)

94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance)

94728 (Airway resistance by impulse oscillometry)

94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination)

94761 (…multiple determinations [e.g., during exercise])

94762 (…by continuous overnight monitoring [separate procedure])

94770 (Carbon dioxide, expired gas determination by infrared analyzer)

Check Modifier Indicator

If your pulmonologist performs polysomnography and pulmonary diagnostic testing, it is best to check CCI edits with the modifier indicator. While the bundling with 94200, 94620, 94660 and 94770 carry the modifier indicator ‘1,’ the rest of the above mentioned codes carry the modifier indicator ‘0.’ "If two codes are bundled by a CCI edit with the modifier indicator "1," then there are circumstances when they could be reported together if a modifier 59 (Distinct procedural service) is used to unbundle the CCI edit," says Plummer.

Don’t Report Parameters Recorded as Separate Service

You will report 95782 or 95783 when your pulmonologist performs a polysomnography for a child aged less than six years recording various parameters such as ECG, EEG, electro-oculogram, sub-mental EMG and the use of C-PAP or bi-level ventilation. You cannot report these parameters recorded as a separate service in addition to reporting 95782 or 95783, according to the CCI edits version 19.0 since they are considered inclusive to the procedure.

So, you cannot report these below mentioned codes along with 95782 or 95783:

92270 (Electro-oculography with interpretation and report)

93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report)-93010 (…interpretation and report only)

93040 (Rhythm ECG, 1-3 leads; with interpretation and report)-93042(…interpretation and report only)

93224 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage…)-93227 (…review and interpretation by a physician or other qualified health care professional)

95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes)-95827 (…all night recording)

95860 (Needle electromyography; 1 extremity with or without related paraspinal areas)-95872 (Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied)

Learn more: For the complete set of the version 19.0 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/.