Pulmonology Coding Alert

Caution: Detach bronchoscopy codes 31626 and 31643 from each other.

If your practice is big on providing pulmonary function testing, make sure to watch out for the latest Correct Coding Initiative (CCI) edits version 17.2, which took effect on July 1, 2011. Edited bundles related to pulmonary stress test (PST), bronchospasm evaluation, and spirometric recording appear in the nonmutually exclusive section of the latest version, along with some sleep testing procedures.

Three out of 322 mutually exclusive (ME) pairs concern pulmonologists, while nonmutually exclusive (NME) edits include 41 out of 2,021 bundles from pulmonologyrelated procedures.

PST Overrides Expiratory Flow Measurement

CCI Edits 17.2 feature 41 nonmutually exclusive pairs that are expected to impact pulmonologists. Nonmutually exclusive edits apply to services that a doctor might carry out during the same encounter, but that are not billable together. These edits are nonbillable because one of the codes (the component code) is included in the services represented by the second, larger (comprehensive) code of the pairing.

Exception: You can bill individual components if the doctor doesn't carry out the entire comprehensive procedure. However, if the doctor carries out the entire (comprehensive) procedure, you should bill only the comprehensive code.

Pulmonology-related NME bundles in CCI Edits 17.2 include comprehensive services performed by physicians as part of pulmonary function test. They are:

• 94621 (Pulmonary stress testing; complex [including measurements of CO2 production, O2 uptake, and electrocardiographic recordings]) paired with components 94011 (Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age), and 94012 (Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age)

• 94620 (Pulmonary stress testing; simple [e.g., 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]) with 94011 and 94012

• 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen[s], cold air, methacholine]) with 94011 and 94012

• 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) with 94011 and 94012

• 94014 (Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation), and 94015 (...recording [includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration]) with 94011

• 94012 with 94200 (Maximum breathing capacity, maximal voluntary ventilation), 94375 (Respiratory flow volume loop), 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour), 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour), and therapeutic, prophylactic, or diagnostic injection codes 96372-96376

• 94011 with 94200 and 94375.

Override your NMEs: Each edit pair carries a modifier indicator of "1," which means you can sometimes bypass the edit by filing your claim with the appropriate modifier, but only if these services were performed at separate sessions for distinct reasons. Ensure you have enough supporting documentation to justify payment for both codes prior to filing with a modifier such as 59 (Distinct procedural service).

Prepare For Sleep Testing-Related NMEs

Also included as NMEs in CCI Edits 17.2 are bundled services typically included in sleep testing, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.

Sleep testing service codes (95807-95811) are comprehensive to procedures:

• 94681 -- Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted
• 94760 -- Noninvasive ear or pulse oximetry for oxygen saturation; single determination
• 94761 -- ...multiple determinations (e.g., during exercise).

Similarly, 95808-95811 are also comprehensive to the following codes:

• 91034 -- Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis and interpretation

• 95905 -- Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report.

Other pairs classified as nonmutually exclusive include:

• 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) and 94360 (Determination of resistance to airflow, oscillatory or plethysmographic methods)

• 95811 and 95824 (Electroencephalogram [EEG]; cerebral death evaluation only).

Three Edits Complete Your Mutually Exclusive Pairs

CCI edits 17.2 categorize three out of 322 mutually exclusive pairs for pulmonology practice. The mutually exclusive table identifies procedures that cannot be reasonably performed on the same day. Many of these edits are based upon the definition of the component that differentiates one code from the other. For instance, 94013 (Measurement of lung volumes [i.e., functional residual capacity (FRC), forced vital capacity (FVC), and expiratory reserve volume (ERV)] in an infant or child through 2 years of age) and 94240 (Functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method) are considered mutually exclusive because both measure and provide information on lung volumes albeit by different methods corresponding to the patient's age.

Check out other codes which you shouldn't pair in the latest version:

• 94011 and 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation)

• 31626 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple) and 31643 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;with placement of catheter[s] for intracavitary radioelement application).