Pulmonology Coding Alert

Changes require more specificity.

CPT® 2012 delivered a load of changes to the way you report thoracoscopy. In addition to including the term "VATS" (video-assisted thoracic surgery) to the thoracoscopy section descriptor, CPT® 2012 also introduced three new codes to represent diagnostic thoracoscopy while phasing out the older codes.

Check out our advice that follows on accurately reporting diagnostic thoracoscopy this year.

Attention! Lung Biopsy Will Now be More Specific

Your options for coding thoracoscopies with a diagnostic biopsy expand in 2012. Now, instead of 32602 (Thoracoscopy, diagnostic [separate procedure]; lungs and pleural space, with biopsy), you will need to report thoracoscopy with biopsy using the newly created codes:

• 32607 -- Thoracoscopy; with diagnostic biopsy[ies] of lung infiltrate[s] {e.g., wedge, incisional), unilateral
• 32608 -- Thoracoscopy; with diagnostic biopsy[ies] of lung nodule[s] or mass[es] [e.g., wedge, incisional], unilateral
• 32609 -- Thoracoscopy; with biopsy[ies] of pleura

Benefits: This CPT® 2012 change has differentiated the three biopsy procedures with three separate codes. So, now you can distinguish thoracoscopy with biopsy that involves an area of the lung with lung infiltrates, nodules or masses and the pleura with separate codes.

"Instead of using a single code to represent multiple types of biopsy in a generalized area (lungs and pleural space) as previously done with CPT® 32602, CPT® 2012 recognizes the varying efforts associated with location as well as the type of tissue you are sampling," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.

The changes are also helpful in getting specific reimbursement for the procedures as the relative value units (RVUs) are different for the three codes as follows: 32607 (~$316, 9.29 total RVUs); 32608 (~$388, 11.41 total RVUs); and 32609 (~$268, 7.89 total RVUs).

Coding Tips: Check the documentation to see if the biopsy involves an area of the lung with lung infiltrates, nodules, masses or the pleura to help arrive at the right thoracoscopy code. Also note that CPT® guidelines state that you can report 32607 or 32608 only once for one lung.

Note This Diagnostic Thoracoscopy Without Biopsy Revision

CPT® 2012 changes the descriptor to 32601 (Thoracoscopy, diagnostic [separate procedure]; lungs, pericardial sac, mediastinal or pleural space, without biopsy) to cover all aspects of diagnostic thoracoscopy (without biopsy). The earlier descriptor to 32601 did not cover diagnostic thoracoscopy (without biopsy) with respect to the pericardial sac and the mediastinal space.

With this change, CPT® now has eliminated codes that covered diagnostic thoracoscopy (without biopsy) with respect to the pericardial sac and the mediastinal space. So, instead of 32603 (Thoracoscopy, diagnostic [separate procedure]; pericardial sac, without biopsy) and 32605 (Thoracoscopy, diagnostic [separate procedure]; mediastinal space, without biopsy), you will only have to report 32601.

E/M service guidance: The newly created codes have been allocated zero global days despite recommendations by the CPT® Advisory Committee. So you cannot report E/M services separately that are provided on the same day apart from the procedural day, unless performed for a separately identifiable reason or when the E/M results in the decision for the procedure. When applicable, a separate E/M is reported with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).