Pulmonology Coding Alert

Skip C9751 with a wide range of testing procedures, E/M encounters. 

In the latest round of Correct Coding Initiative (CCI) Procedure-to-Procedure (PTP) edits, (version 25.2), effective July 1, CMS delivers the following additions that address outpatient facility-based bronchial lesion ablation and a long list of other procedures and E/M services. Here’s the lowdown.

Watch for Donor Lung Testing Bundles

For lung transplant procedures, CCI adds bundles for the inpatient-only codes below for perfusion testing services on the donor lung/s:

• 0495T (Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified health care professional, including physiological and laboratory assessment (eg, pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance and perfusate gas analysis), including bronchoscopy and X ray when performed; first two hours in sterile field)
• +0496T (… each additional hour (List separately in addition to code for primary procedure)).

You’ll find 0495T and +0496T are now Column 1 codes to HCPCS transbronchial lesion ablation code C9751 (Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by microwave energy, including fluoroscopic guidance, when performed, with computed tomography acquisition(s) and 3-d rendering, computer-assisted, image-guided navigation, and endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]) and all mediastinal and/or hilar lymph node stations or structures and therapeutic intervention(s)), which is a Column 2 code for this edit pairing.

Keep in mind: Code C9751 is a facility code, not a physician code, and would be reported by the facility using the Outpatient Prospective Payment System (OPPS), advises Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.

Unwrapping the bundle: CCI 25.2 lists a modifier indicator of “1” for these bundles, allowing you to append an appropriate modifier such as modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to C9751 to indicate a distinct separate service and unbundle the code pair if it’s ever appropriate and supported by procedure documentation.

Injections, Wound Care, and Tests Make the Edits List

C9751 is also listed as a Column 1 code for a host of procedures (when reported by the facility via OPPS) including:

• Facet joint injections (0213T) and lumbar epidural injections (0230T). (You won’t be able to unbundle these injection pairs, as the modifier indicator is 0.)
• Fine needle aspiration biopsy codes (10005-10011, 10021)
• Debridement procedures (11000-11006, 11042-+11047)
• Wound repair (12001-12057, 13100-+13153)
• Laryngoscopies (31525-31575)
• Endoscopies and bronchoscopies (31615-31653). In this range, just a few codes (31615 for tracheobronchoscopy, bronchoscopy with biopsy code 31625, and bronchoscopy with tumor excision code 31640) have a modifier indicator of 1, meaning you can unbundle the pair and append modifier 59 if it’s a substantiated separate procedure from the transbronchial lesion ablation described in C9751. The others have an indicator of 0, so you can’t ever bill those procedures with C9751. 
• Bronchial catheterization (31725); needle/intercatheter insertion (36000-36640); bladder catheterization (51701-51703). All of these have a modifier indicator of 0, so you can’t unbundle these.
• Injections (62320-62327; 64400-+64495) 
• Operating microscope code (69990), also with a modifier indicator of 0.
• Radiology services (71250-71275, 76000-76377, +77001-+77002).

There’s more: You’ll also find a range of testing procedures and E/M codes bundled with C9751, including established and new office visits, hospital inpatient and subsequent care codes, and inpatient consultations.

Resource: To see the quarterly CCI PTP edits, including version 25.2, go to  www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes.html.