Pulmonology Coding Alert

For pulmonologists, the most important revisions in Correct Coding Initiative (CCI) version 8.3 bundle injection codes into the surgical respiratory codes the physicians frequently use. Version 8.3 lists more than 54,000 code-pair additions (i.e., new edits) and only four deletions. This is more than three times as many additions as those included in version 8.2, which was released in July. The fourth-quarter revisions went into effect Oct. 1 and contain several changes that affect pulmonologists. Injections Bundled Into Surgery The most significant change in version 8.3 is that it now bundles many injection codes into respiratory surgical procedures, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist for the department of medicine at the University of Pennsylvania in Philadelphia. These procedures include bronchoscopy (31615-31656), thoracentesis (32000-32002) and chest tube insertion (32020). Each of these procedure codes now includes the following injection codes: 36000* Introduction of needle or intracatheter, vein 36410* Venipuncture, child over age 3 years or adult, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes. Not to be used for routine venipuncture 37202 Transcatheter therapy, infusion other than for thrombolysis, any type (e.g., spasmolytic, vasocon-strictive) 62318 Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic 62319 lumbar, sacral (caudal) 64415* Injection, anesthetic agent; brachial plexus 64417* axillary nerve 64450* other peripheral nerve or branch 64470 Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level 64475 lumbar or sacral, single level 90780 Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour. For example, a pulmonologist performs a bronchoscopy with biopsy (31625). Before beginning the procedure, he inserts a needle into the patient's vein (36000) and infuses (90780) her with midazolam (Versed) and/or a narcotic such as meperidine (Demerol) for conscious sedation. Under the new CCI edits, you would bill only 31625 because payment for 36000 and 90780 is now bundled into the bronchoscopy reimbursement, Pohlig says. Before CCI 8.3, you would not have billed these codes together because payers considered 36000 and 90780 part of 31625, she adds. "This new edit brings the CCI more in line with current practices."

Similarly, CCI version 8.3 has bundled injection code 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) into allergen immunotherapy codes 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 ( two or more injections). And spirometry code 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [...]