Pulmonology Coding Alert

Evaluation and Management coding get a fresh look too.

You are just halfway through with 2012, but the CPT® Editorial Committee is already gearing up for the coming year with its new list of proposals for the year 2013. As a pulmonology coder, you will need to brace yourself for many changes, including thoracentesis, pleural drainage, vaccine and polysomnography codes in 2013.

Reminder: Although the editorial committee has posted these changes, it is not essential that all these changes will be taken forward in CPT® 2013. As the editorial notes indicate, "Codes are not assigned, nor exact wording finalized, until just prior to publication."

Watch out for New Codes to Thoracentesis and Pleural Drainage

The CPT® editorial committee has accepted the proposal for the establishment of four new codes for thoracentesis and pleural drainage (325X1-325X4). These codes are proposed to replace the existing code sets 32420 (Pneumocentesis, puncture of lung for aspiration), 32421 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) and 32422 (Thoracentesis with insertion of tube, includes water seal [e.g., for pneumothorax], when performed [separate procedure]) as these codes will be deleted in 2013.

Bronchial Thermoplasty Gets Upgraded

If the proposals of the committee come into force, you might gain the advantage of being able to report a bronchial thermoplasty when your pulmonologist performs it in 2013.

If you were using the category III codes 0276T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe) or 0277T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes) to report bronchial thermoplasty performed by your pulmonologist as a treatment for severe asthma, expect to report them in 2013 using category I codes 316XX1-316XX2 if the CPT® committee proposals come forth. "This may help with coverage issues as some payers consider Category III codes as "investigational" and disallow coverage," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania, Department of Medicine in Philadelphia.

CPT® Proposed Many Changes to Vaccine Codes

The trend in overhauling vaccine codes continues in 2013 as updated vaccines spark CPT® changes. Look for the following changes to vaccine codes in 2013:

• Descriptors to influenza vaccines codes 90655-90658 might include the term "trivalent" to help distinguish these vaccines from the newest quadrivalent influenza vaccines.
• The descriptor to 90660 ((Influenza virus vaccine, live, for intranasal use) might also get altered to incorporate the term "trivalent" while a new code range 906XX might be created to include intranasal quadrivalent influenza vaccines.
• The new code series (906XX) proposed to be introduced might include a code to report an adjuvant influenza vaccine.
• Code 90718 (Tetanus and diphtheria toxoids [Td] adsorbed when administered to individuals 7 years or older, for intramuscular use) might get scrapped while 90714 (Tetanus and diphtheria toxoids [Td] adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use) might have to be used universally to report all the tetanus and diphtheria products.

"Vaccine code specification requires increased accuracy in reporting, but also allows for a more cost-effective system in which the reimbursement can accurately reflect the individual costs corresponding to the various codes," adds Pohlig.

Check These Proposed Overhauls to E/M Services

If the proposed revisions to CPT® 2013 come into effect, you might see a major overhaul to the way you report E/M services performed by your pulmonologist. Some of these proposed changes include:

• Revision to the guidelines of the pulmonary subsection of codes 94010-94799 to include a specific listing of evaluation and management CPT® codes.
• Revisions to the CPT® guidelines in the Medicine/Vaccine/Toxoid Administration subsection to include a specific listing of applicable evaluation and management CPT® codes.

Polysomnography Expands Age Limit

Among other changes that have been proposed that have a bearing on pulmonology coders, you might see the establishment of a new code set 958X1X-958X2X when your pulmonologist performs sleep studies such as polysomnography to a child below the age of 6. Also, the current descriptors to 95808 (Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist) might be revised to include the term "any age" and the existing polysomnography codes 95810 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist) and 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) might include the age specification of being above the age of 6.

In addition, CPT® 2013 might bring an end to bronchography codes 31656 (Bronchoscopy...segmental bronchography [fiberscope only]), 31715 (Transtracheal injection for bronchography), 71040 (Bronchography, unilateral, radiological supervision and interpretation) and 71060 (Bronchography, bilateral, radiological supervision and interpretation) as CT is now preferred over bronchography and the latter is no longer in use.