Pulmonology Coding Alert

Bronchoscopy codes will no longer include conscious sedation.

As the year starts winding down, you need start preparing for the next — especially as the AMA has finally released the CPT^® 2017 update. Here’s a rundown of the types of changes you might see in January.

New codes for central sleep apnea: Look forward to the implementation of the following 13 new category III codes on insertion, removal and repositioning of the neurostimulator system for treating central sleep apnea:

• 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])
• 0425T (…sensing lead only)
• 0426T (…stimulation lead only)
• 0427T (…pulse generator only)
• 0428T (Removal of neurostimulator system for treatment of central sleep apnea; pulse generator only)
• 0429T (…sensing lead only)
• 0430T (…stimulation lead only)
• 0431T (…pulse generator only)
• 0432T (Repositioning of neurostimulator system for treatment of central sleep apnea; stimulation lead only)
• 0433T (…sensing lead only)
• 0434T (Interrogation device evaluation 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)
• 0436T (…during sleep study)

Watch Out As Many Codes Get Stripped Off Conscious Sedation

Looking into the initial list of changes could have been confusing because some codes that are marked as revisions for 2017 had the same descriptor that’s currently in place. Perhaps they changed the RVUs, which weren’t listed. “Proposed changes and actual changes can sometimes be quite different than expected,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania. As the final CPT^® updates are out now, you will have to dig into Appendix B — which is a summary of additions, deletions, and revisions; there, you can “learn those final details,” says Pohlig.

A major highlight of CPT^® 2017 update is the removal of the conscious sedation symbol from the more than 400 codes. That symbol meant the moderate sedation was already included in the procedure code and that you would not report moderate/conscious sedation in addition to the procedure code. However, with the removal of the conscious sedation mark, these codes will no longer include moderate sedation. In other words, if the physician performs conscious sedation, you would need to report it separately in order to be reimbursed. Read on to learn the codes from which CPT^® will remove the conscious sedation.

Revision in bronchoscopy procedures: You should expect a major overhaul in the bronchoscopy codes, the 316XX series, including the EBUs codes added in 2016. In fact, 24 codes related to bronchoscopy, rigid or flexible, including fluoroscopic guidance, are all set to be updated in 2017. The revision includes the removal of conscious sedation from codes such as:

• 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]) to 31651 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve[s], each additional lobe [List separately in addition to code for primary procedure(s)]) — a total of 18 codes.
• The EBUs codes 31652 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with endobronchial ultrasound [EBUS] guided transtracheal and/or transbronchial sampling [e.g., aspiration(s)/biopsy(ies)], one or two mediastinal and/or hilar lymph node stations or structures) to 32654 (…during bronchoscopic diagnostic or therapeutic intervention[s] for peripheral lesion[s] [List separately in addition to code for primary procedure(s)])
• 31660 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe) to 31725 (…when performed; tracheobronchial with fiberscope, bedside)
• 32405 (Biopsy, lung or mediastinum, percutaneous needle)
• 32550 (Insertion of indwelling tunneled pleural catheter with cuff)
• 32551 (Tube thoracostomy, includes connection to drainage system [e.g., water seal], when performed, open [separate procedure])

Furthermore, you should no longer consider conscious sedation included in the codes on measurement of lung volumes and spirometric forced expiratory flows:

• 94011 (Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age)
• 94012 (Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age)
• 94013 (Measurement of lung volumes [i.e., functional residual capacity (FRC), forced vital capacity (FVC), and expiratory reserve volume (ERV)] in an infant or child through 2 years of age)

Final takeaway: A major overhaul involving removal of conscious sedation component from the bronchoscopy codes would mean that providers would need to report the sedation services separately, and figure out how to report these services appropriately. Look out for more information in upcoming issues, on how to impeccably report these services.