Pulmonology Coding Alert

Pulmonologists aren’t facing scores of code updates in the New Year.

As a pulmonology coder, there are years when you are hoping for new codes to describe the services your physicians perform, and there are years when the existing code set suits you just fine. Hopefully this year comes into the latter category for you, because the latest edition of CPT^® doesn’t provide any dramatic changes to the way chest care practices will report their services.

Get Ready for PICC Line Overhaul

PICC line insertions are common for critical care patients, often used as essential tools in delivering antibiotics or other medications. In the past, you’ve been reporting the appropriate PICC line codes along with a separate code for imaging guidance, but the new year will bring a fresh set of codes that will bundle the PICC line insertion with the imaging guidance, allowing you to report just one code instead of submitting multiple line items on your claims.

The two new codes that include imaging guidance are as follows:

• 36572 –  Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age
• 36573 – … age 5 years or older

The addition of these new codes means that CPT^® had to revise the existing codes in the PICC line placement series to clarify that imaging is not included in those. You’ll use these revised codes when the provider inserts a PICC line without the assistance of imaging guidance. Emphasis added by Pulmonology Coding Alert – the bolded words are new for 2019:

• 36568 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age
• 36569 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older

The final adjustment to this code set involves the PICC line replacement code 36584, which has been revised to indicate that imaging guidance, documentation, and radiological supervision/interpretation are all included in payment for the service. The revised code is as follows, with the new verbiage bolded by Pulmonology Coding Alert:

• 36584 –  Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement.

Prep for Major FNA Updates

If your pulmonologist ever performs fine needle aspiration (FNA), you’ll find big changes awaiting you in the latest edition of CPT^®. Much like the PICC code changes, the updates to FNA codes involve radiological guidance and include nine additions (10004-10012), one revision (10021), and a deletion of 10022 (Fine needle aspiration; with imaging guidance).

The reason 10022 is being deleted is because the American Medical Association’s Relativity Assessment Workgroup identified it “as being reported together with [ultrasound code] 76942 more than 75 percent of the time, resulting in referral to the CPT^® Editorial Panel for a bundling,” the American College of Radiology said on its website.

Existing code 10021 has been revised, with the new descriptor reading “Fine needle aspiration biopsy, without imaging guidance; first lesion.” The bolded words are new for 2019 and reflect the fact that CPT® is creating additional add-on codes to reflect additional lesions that the physician addresses.

The new codes reflect the type of guidance used, as well as add-on codes for additional lesions. For instance, the following codes will join the CPT^® ranks effective Jan. 1:

• +10004: Fine needle aspiration biopsy, without imaging guidance; each additional lesion (List separately in addition to code for primary procedure)
• 10005: Fine needle aspiration biopsy, including ultrasound guidance; first lesion
• +10006: Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure)
• 10007: Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
• +10008: Fine needle aspiration biopsy, including fluoroscopic guidance; each additional lesion (List separately in addition to code for primary procedure)

The remaining codes describe FNA with CT guidance (10009 and +10010) or with MR guidance (10011 and +10012).

Example: Suppose a patient presents with two separate abscesses and the physician performs a needle aspiration biopsy on both without imaging guidance. In this case, you’d report 10021 and one unit of +10004.