Pulmonology Coding Alert

Don’t forget to take into account descriptor changes to old code sets.

When your pulmonologist performs polysomnography (PSG) or allergy testing after Jan.1, 2013 don’t forget to consider changes that CPT® has introduced to these services -- you’ll now have to factor in the age of the patient when reporting PSG while allergy testing now covers more than just physicians.

Upgrade PSG Coding With 95782 and 95783

We previously covered that in 2013 you will have expanded coding options for reporting polysomnography depending on age. You now have two new codes to report when your pulmonologist performs these services to a child aged below six.

• 95782 (Polysomnography, younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist)
• 95783 (Polysomnography, younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist)

When you report corresponding PSG services performed by your pulmonologist to a person aged 6 or above, you will use the previous code sets (95810 -- 95811). However, you will have to take into account the descriptor changes that will be initiated starting Jan.1, 2013. The underlined portions in the descriptor indicate new changes that will be incorporated into the existing code sets for PSG:

• 95808 (Polysomnography; any age sleep staging with 1-3 additional parameters of sleep, attended by a technologist)
• 95810 (Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist)
• 95811 (Polysomnography; age 6 years or older, 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)

Reminder: When your pulmonologist performs a basic polysomnography recording only 1-3 additional parameters of sleep, you will report 95808, regardless of the age of the patient.

Example: Your pulmonologist assesses a 5-year-old patient for obstructive sleep apnea. His mother complains that the child often snores during sleep, and sometimes gasps for breath during sleep. She also complains that the child has his mouth open and is usually breathing through his mouth during sleep. Of late, she has observed that the child has problems with concentration in his studies at school that is affecting his performance. Since your pulmonologist wants to assess the child for OSA, he orders for a polysomnography recording EEG, submental EMG, Electrooculogram (EOG), nasal pressure, ECG, end tidal PCO2, SPO2, and body positions.

Because your pulmonologist records more than four additional parameters above the standard parameters (EEG, EOG and submental EMG) you can report the PSG with 95782.

Allergy Revisions, Deletions, and Additions Help Allow More Coverage

In 2013, you’ll see many changes to allergy reporting as many of the previous codes that you used to report these services will now see descriptor changes allowing coverage when a qualified health professional such as a NP or a PA provide these services.

"The new wording correlates to the physician option of delegating this responsibility to another individual who is licensed and qualified to perform the interpretation and report, such as an NP or PA," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania, Department of Medicine in Philadelphia

Note: The new wording is underlined, and you’ll see the deleted wording via the strikethroughs.

Revisions: For instance, you’ll see that 95004 (Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests) deletes the phrase "by a physician."

You’ll find a similar revision to 95024 (Intracutaneous [intradermal] tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests) and 95027 (Intracutaneous [intradermal] tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report by a physician, specify number of tests).

CPT® clarifies who can perform allergen immunotherapy by adding the following revision to 95120-95134 (Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract …).

Keep in mind: Even though descriptor changes allow reporting allergy testing performed by a NP or a PA, you should be aware of supervisory guidelines so that you do not risk denials to your claims. "There continues to be an element of "physician work" involved in these codes which lies in the test interpretation and report," says Pohlig. "Most operations are set up, with the testing usually performed by an allergy nurse and the immunotherapy also administered by an allergy nurse," says Barbara Cobuzzi, MBA, CPC, CENTC, CPCH, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. "The practice, however, still has to be concerned with following the diagnostic supervisory guidelines for allergy testing and incident-to guidelines for providing immunotherapy when these injections are administered by someone other than the physician."

Deletions: You should delete 95010 (Percutaneous tests [scratch, puncture, prick] sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests) and 95015 (Intracutaneous [intradermal] tests, sequential and incremental, with drugs, biologicals, or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests) from your coding cache.

Also, you will no longer use 95075 (Ingestion challenge test [sequential and incremental ingestion of test items, e.g., food, drug or other substance such as metabisulfite]).

Additions: Then, you should add 95017 (Allergy testing, any combination of percutaneous [scratch, puncture, prick] and intracutaneous [intradermal], sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests) and 95018 (Allergy testing, any combination of percutaneous [scratch, puncture, prick] and intracutaneous [intradermal], sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests).

You should also add 95076 (Ingestion challenge test [sequential and incremental ingestion of test items, e.g., food, drug or other substance]; initial 120 minutes of testing) and +95079 (…each additional 60 minutes of testing [List separately in addition to code for primary procedure]).