Pulmonology Coding Alert

Plus: You’ll find five deleted PFT codes in 2021.

You’ve been awaiting the looming updates to the E/M section of CPT^® for some time, but you’ll also find a few surprises headed your way when the new code set takes effect on Jan. 1, 2021. That’s because CPT^® 2021 includes over 200 changes, several of which will be of great interest to pulmonology practices.

Look for Changes to Exercise Test Series

Among the most significant updates affecting pulmonology coders is the new addition to the exercise test category, which allows you more specificity in your code choices.

Breakdown: Effective Jan. 1, you’ll find new code 94619 (Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; without electrocardiographic recording(s)) to describe the exercise tests you administer for bronchospasm when no electrocardiographic recordings are performed.

As a result, the parent code, 94617, has been revised. Whereas the current descriptor is “Exercise test for bronchospasm, including pre- and post-spirometry, electrocardiographic recording(s), and pulse oximetry,” the new one will instead say “Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic recording(s).”

The changes will allow coders to more accurately determine which code should be reported when ECG recordings are performed (94617) and when they aren’t (94619). In the past, when ECG was not performed, coders were unsure of how to bill the service, with many appending modifier 52 (Reduced services) to 94617. However, the addition of the new code will make it so the modifier is no longer necessary.

Deletions, Revisions Could Make Big Impact

Other big news in CPT^® 2021 involves the codes you won’t find in your updated code book. The following pulmonary function testing codes have been deleted effective Jan. 1, 2021:

• 94250 (Expired gas collection, quantitative, single procedure (separate procedure))
• 94400 (Breathing response to CO2 (CO2 response curve))
• 94750 (Pulmonary compliance study (eg, plethysmography, volume and pressure measurements))
• 94770 (Carbon dioxide, expired gas determination by infrared analyzer)
• 95071 (Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with antigens or gases, specify)

Many of the above codes were used infrequently, due to a combination of National Correct Coding Initiative (NCCI) bundles and advancements in testing. In addition, 95071 was a “technical-only” code, and NCCI has long bundled it into 94070, which is comprised of a technical and professional component, notes Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania:

In addition to the deletions, you’ll find a revision to code 95070, the descriptor for which will state “Inhalation bronchial challenge testing (not including necessary pulmonary function tests), with histamine, methacholine, or similar compounds” in 2021. Although the difference may not be obvious at first, it lies in the punctuation and not in the verbiage. Whereas a semicolon used to precede “with histamine, methacholine, or similar compounds,” a comma is now in that slot.

With the deletion of 95071, CPT^® no longer required a differentiator between 95070 as the parent code and 95071 as the child code, thus inspiring the punctuation adjustment.

Get a Handle on Prolonged Service Codes

In addition to the E/M changes that pulmonology practices have been expecting, CPT^® 2021 will add new prolonged services code +99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)).

You should report +99417 “to report prolonged total time (ie, combined time with and without direct patient contact) provided by the physician or other qualified health care professional on the date of office or other outpatient services (ie, 99205, 99215),” according to CPT^®. However, you should only report +99417 “when the office or other outpatient service has been selected using time alone as the basis and only after the total time of the highest-level service (ie, 99205 or 99215) has been exceeded.”

Don’t miss: For all other non-office/outpatient E/M code sets that may be coded based on the 1995/1997 guidelines for time-based coding, you’ll continue to use the existing prolonged services code range +99354-+99357 (Prolonged service with direct patient contact).

Keep an eye on future issues of Pulmonology Coding Alert for more details about how to use the adjusted code set as information is released.