Pulmonology Coding Alert

Include category III ECG procedures in new home sleep study type III and IV services.

The latest version of Correct Coding Initiative edits (CCI 17.0) takes effect Jan. 1 and sheds light on new home sleep study codes 95800 and 95801 as comprehensive procedures of common cardiovascular test codes such as electrocardiogram, stress test, and rhythm ECG.

Other main edits you want to be sure to watch for include the following debuting CPT codes:

• 31634 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance [e.g., fibrin glue], if performed),
• 90470 (H1N1 immunization administration [intramuscular, intranasal], including counseling when performed),
• 0250T (Airway sizing and insertion of bronchial valve[s], each lobe [List separately in addition to code for primary procedure]),
• 0251T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve[s], initial lobe), and
• 0252T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve[s]), each additional lobe [List separately in addition to code for primary procedure]).

95800, 95801 Receive the Most NME Edits

Column 1/Column 2 codes are services that physicians often perform during the same session that are not billable together, with Column 1 as the comprehensive or larger procedure and Column 2 as the component. The component code is included in the services represented by the comprehensive code when performed by the same physician/group on the same date.

CCI Edits 17.0 includes edits for component procedures when performed with 95800 (Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis [e.g., by airflow or peripheral arterial tone], and sleep time) and 95801 (Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis [e.g., by airflow or peripheral arterial tone]). These component procedures include:

• 0178T-0180T (electrocardiogram),
• 0243T-0244T (measurement of wheeze rate for bronchodilator),
• 93000-93010 (routine electrocardiogram),
• 93040-93042 (rhythm ECG),
• 93224-93227 (wearable eletrocardiographic rhythm),
• 93228-93229 (wearable mobile cardiovascular telemetry),
• 93268-93272 (wearable patient activated electrocardiographic rhythm)
• 94200 (Maximum breathing capacity, maximal voluntary ventilation),
• 94660 (Continuous positive airway pressure ventilation (CPAP), initiation and management),
• 94762 (Continuous negative pressure ventilation (CNP), initiation and management),
• 95803 (Actigraphy testing, recording, analysis, interpretation, and report [minimum of 72 hours to 14 consecutive days of recording]).

Meanwhile, bronchoscopy with balloon occlusion (31634) is considered a comprehensive procedure to:

• 00520 (Anesthesia for closed chest procedures, [including bronchoscopy] not otherwise specified),
• 0213T-0216T (ultrasoundguided paravertebral facet joint injection),
• 0251T
• 31231(Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]),
• 31525 (Laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn),
• 31535 (Laryngoscopy, direct, operative, with biopsy),
• 31575 (Laryngoscopy, flexible fiberoptic; diagnostic),
• 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]),
• 31717 (Catherization with bronchial brush biopsy),
• 31720 (Catheter aspiration [separate procedure]; nasotracheal),
• 31725 (...tracheobronchial with fiberscope, bedside),
• J0670 (Injection, mepivacaine hydrochloride, per 10 ml),
• J2001 (Injection, lidocaine hcl for intravenous infusion, 10 mg), and
• 99143-99150 (moderate sedation services).

Way around: If an edit pair carries a modifier indicator of "1," it means you can bypass the edit by filing your claim with an appropriate modifier if the service was performed at a separate session or for a reason that is separate from the procedure. Be sure you have enough supporting documentation to justify payment for both codes before filing with a modifier such as 59 (Distinct procedural service). For instance in CCI Edits 17.0, the 31634-31720 bundle carries a modifier indicator of "1," while the 31634-0216T has "0."

Example: The edit involving 95800 and 93000 doesn't apply if a physician performed ECG on the same day as a sleep study since the sleep study is performed by another specialty group, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.

Joining 95801 with 95803 Is A No-No

CCI Edits 17.0 notes that 95800, 95801, and 95803 (Actigraphy testing, recording, analysis, interpretation, and report [minimum of 72 hours to 14 consecutive days of recording]) are included in other sleep testing codes. For instance, 95800 and 95801 are bundled into 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort [e.g., thoracoabdominal movement]), while 95801 and 95803 are components of 95800.

Meanwhile, CCI cites "misuse of column two code with column one code" as reason for 95801/95803 edit. This bundle carries a modifier indicator of "0" which doesn't allow the procedures to bypass the edits, resulting in a denial.

Nix Bundling CPT/HCPCS Home Study Codes

Mutually exclusive edits contain coding combos that CCI maintains cannot be reasonably performed in the same session. Version 17.0 lists several mutually exclusive edits for pulmonology, including:

• CPTs 95800 and 95801, respectively, with HCPCS home sleep study codes G0398- G0400
• 95807 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist), and polysomnography codes 95808-95811, with 95800, 95801, and 95806
• 31634 with 31615 (Tracheobronchoscopy through established tracheostomy incision).