Pulmonology Coding Alert

Check out this new bronchoscopy with balloon occlusion code.

If you perform sleep studies, prepare to upgrade your coding style come Jan. 1. CPT 2011 reserves some big changes for pulmonology, so find out which code sets make it to next year with revisions, and which new codes you'll have to learn to use.

Warning: You've got to get started with CPT 2011 codes on or after Jan. 1. If you continued using inactive or unrevised codes, you'd surely be risking denials.

Sleep Study Debuts Two New Codes

What's more exciting than the completion over the past three years of the transition of home sleep study codes from temporary G codes to CPT category III codes to accepted CPT category I codes?

The good news: Home sleep studies type II had made a straight transition from G0398 to 95806 in CPT 2010. The codes for home sleep studies type III and IV now have their own category I codes for 2011:

• 95800 -- Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
• 95801 -- Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone).

CPT has established these sleep study codes for reporting unattended sleep study testing services. These codes appear with a number (#) symbol to indicate that they are out of numerical sequence. This table shows the codes you'll use and the tests they represent:

More New Pulmonology Codes on Spotlight

For trachea and bronchi, a new code (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) has been created to report bronchoscopy with balloon occlusion, with assessment of air leak, with the administration of occlusive substance, if performed. Other new codes that have made it to the cut for CPT 2011 include:

• 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
• 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).

CPTs 0250T, 0251T, 0252T have not been assigned any physician work RVUs. This means that payment is only received by the facility for these services, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at theUniversity of Pennsylvania Department of Medicine in Philadelphia.

Photodynamic Therapy Guidelines and Others Find Revisions for 2011

Aside from debuting sleep study codes and several others, CPT 2011 has revised photodynamic therapy coding. Beginning Jan. 1, you should pay attention to the documented time in case a modifier is necessary.

CPT 2011 adds several parenthetical guidelines after codes 96570 and 96571. "If the pulmonologist performs 96570 for less than 23 minutes, report modifier 52," noted Scott Manaker, MD, PhD, American College of Chest Physicians, AMA/Specialty Society Relative Value Scale Update Committee (RUC) Member. For each increment after the first 30, you have to get to the eighth minute for each interval, he noted.

Other CPT 2011 revised codes include:

• 90662 -- Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
• 90663 -- Influenza virus vaccine, pandemic formulation, H1N1
• 90670 -- Pneumococcal conjugate vaccine, 13 valent, for intramuscular use.

E/M Changes Offer a Sneak Peek

CPT 2011 has made significant revisions to the hospital observation services section, including the addition of three new resequenced codes in the subsequent hospital observation subsection. Additional revisions have also been made in the hospital inpatient services, pediatric critical care patient transport, and inpatient neonatal and pediatric critical care subsections.

Check out three new E/M codes that can have effect your pulmonology practice's coding success.

Scenario: "Middle days" observation care where a patient is admitted to observation and remains in that status for three or more days. CPT 2011 addresses this with three new codes:

• 99224 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit.
• 99225 -- ... an expanded problem focused interval history; an expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are rovided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.
• 99226 -- ... a detailed interval history; a detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.