Pulmonology Coding Alert

Don’t lose sleep over exclusive codes for removal, replacement, repositioning and more.

Your coding for sleep apnea will undergo a major overhaul in 2017, as over a dozen sleep apnea codes enter the CPT^® code book 2017. Read on for a lowdown on the specifics of the new codes, to help you with options for insertion, replacement, removal of the device, and more.

Basics: Central sleep apnea is an arrest of breathing that can impair cardiovascular function and lead to death. The new codes report insertion, replacement, repositioning and evaluation of the neurostimulator device and leads that providers use in the treatment of sleep apnea.

“The need for these codes [arose] due to the development of new technology,” says Carol Pohlig, BSN, RN, CPC, ACS,  senior coding and education specialist at the Hospital of the University of Pennsylvania. “It may be a while before this service is rendered effective and covered.”

These are temporary codes or category III codes that are added to report (and track) new procedures, services, and technologies.

Gear up For 4 New Insertion or Replacement Codes

In the year 2017, you will have 0424T (Insertion or replacement of neurostimulator system for treatment of central sleep apnea; complete system [transvenous placement of right or left stimulation lead, sensing lead, implantable pulse generator]) to report the insertion or replacement of a neurostimulator system for treatment of central sleep apnea. The system consists of a transvenously placed right or left stimulation lead, a sensing lead, and an implantable pulse generator.

This code includes vessel catheterization, and all image guidance the provider requires for the procedure, and interrogation and programming, when performed.

More codes: Get ready to use a new code range 0425T-0427T (Insertion or replacement of neurostimulator system for treatment of central sleep apnea… ) when your provider performs insertion or replacement of only a sensing lead, stimulation lead, or a pulse generator alone, respectively. This is in contrast to 0424T, which stands for insertion or replacement of the entire neurostimulator system.

Coding example: The provider sees a patient with known central sleep apnea, with an implanted neurostimulator system, for a follow up visit. The provider is not satisfied with the function of the machine, and chooses to replace the sensing lead and the pulse generator components. How do you code for this?

First, you will report the diagnosis, G47.31 (Primary central sleep apnea), and then add the new procedure codes 0425T and 0427T, to report the parts the provider replaced.

These codes will help you report the equipment handling procedures inherent to clinical sleep apnea studies. “Keep track of any clinical trials or registries that may be initiated in order to collect more data about this service,” Pohlig says. “If your provider participates in these types of data collection projects, the equipment and related technical costs may be covered.”

Apply a Separate Set of 4 Codes for Removal

If your provider removes one of the individual parts of the implanted neurostimulator system, you have fresh codes to report those too. Choose from the code range 0428T-0430T (Removal of neurostimulator system for treatment of central sleep apnea…) to report the removal of the pulse generator, sensing lead or stimulation lead respectively.

Plus: While 0428T refers to mere removal of the pulse generator of the neurostimulator system, you get another new code option 0431T (Removal and replacement of neurostimulator system for treatment of central sleep apnea, pulse generator only), to report for both the removal and replacement of a pulse generator for a neurostimulator system.

Scenario 1: If your provider is replacing less than a complete system, report appropriate codes from 0425T, 0426T, and 0427T (for sensing lead, stimulation lead or pulse generator, respectively). Even if he replaces all the three components, you may report only 0424T in conjunction with codes for removal of each of the components (0428T, 0429T, 0430T).

Scenario 2: If the provider removes and replaces the pulse generator plus all three leads, report 0424T in conjunction with 0428T, 0429T, 0430T.

Scenario 3: If the provider removes the entire system, report 0428T for pulse generator removal plus 0429T or 0430T for each transvenous lead removal.

Exclusive codes for repositioning: CPT^® 2017 also includes new codes specific to repositioning of the stimulation lead and sensory lead of the neurostimulator system.

• 0432T (Repositioning of neurostimulator system for treatment of central sleep apnea; stimulation lead only).
• 0433T (…sensing lead only).

Remember, not to report the repositioning codes 0432T or 0433T along with the insertion or replacement codes 0424T-0427T.

Note New Codes for Interrogation and Programming Device Eval

Once your provider has fixed the system and the leads, don’t think you are done with your code reporting work. You get new codes for device evaluation as well. The new codes for interrogation device evaluation and programming device evaluation include multiple parameters like rate, pulse amplitude, pulse duration, configuration of waveform, battery status, electrode selectability, output modulation, cycling, impedance, and patient compliance measurements. The codes are:

• 0434T (Interrogation device evaluation implanted neurostimulator pulse generator system for central sleep apnea) — to report the interrogation device evaluation of an implanted neurostimulator pulse generator system for central sleep apnea.
• 0435T (Programming device evaluation of implanted neurostimulator pulse generator system for central sleep apnea; single session) — to report a single session, programming device evaluation of an implanted neurostimulator pulse generator system for central sleep apnea.
• 0436T (… during sleep study) — to report programming device evaluation of implanted neurostimulator pulse generator system for central sleep apnea, during sleep study.

“Until now, there was no code to represent the service,” Pohlig says. “An unlisted code could have been used, but most payers render this service experimental so billing would not have been permitted, and still is not for most (if not all) payers.”

What’s more, you will need to be careful in keeping track of when and how to report these codes.

Scenario: The provider performs programming of the neurostimulator device for a patient during an overnight sleep study. He needs to make programming changes several times in the study, to reach an acceptable functional status of the device. In such a case, it would suffice to report 0436T only once, you need not report this code more than once based on the numerous attempts of the provider.

Caveat: These programming codes 0434T-0436T are quite exclusive and do not go along with the removal, replacement or repositioning codes 0424T-0433T.

Final takeaway: Most payers consider this procedure as well as the device investigational, so check with the payer regarding their policies. “Payers should recognize them and assign a reimbursement amount based on provider contract,” says Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president, Healthcare Resource Management, Inc. Spring Lake, NJ. Regardless of coverage, the procedure should still be reported for tracking and statistical purposes when performed.