Pulmonology Coding Alert

The CPT 2002 manual will be available in November 2001. An early release of new and revised codes by the AMA, however, has provided a preview of changes. Revisions affecting pulmonology are few and generally serve only to clarify or narrow previous definitions. In most cases, the revised descriptors do not affect the code application.
 
Although only time will tell how CMS and private payers will respond to the revisions and newly added codes, all physician offices should begin preparing now for the changes. CPT 2002 is officially effective Jan. 1, 2002, but not all payers adopt changes uniformly. Check with your carrier before billing any of the revised codes outlined below.
 

Bronchoscopy  
Bronchoscopy code 31641 now includes the example of cryotherapy as an acceptable method of tumor destruction and relief of stenosis, but does not otherwise affect its use (new text has been bolded):
  31641 bronchoscopy, (rigid or flexible); with destruction of tumor or relief of stenosis by any method other than excision (e.g., laser therapy, cryotherapy).  
Cryotherapy (also known as cryocautery, cryosurgery or cryoconization) is a method of treatment that destroys abnormal tissue by freezing it. A probe is placed in contact with the tissue to be frozen. Nitrous oxide circulates through the probe, causing the tip to become extremely cold, about -89 C. The area to be treated is usually "frozen" twice, i.e., freeze, thaw, freeze, thaw.
Immunization Administration  
Two new immunization codes have been added to report more precisely administration by intranasal or oral route. Code 90471, previously used for administration by percutaneous, intradermal, subcutaneous, intramuscular and jet injections, as well as by intranasal or oral route, has been revised to reflect the availability of the new codes.  
  90471 immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections); one vaccine (single or combination vaccine/toxoid)
  90473 immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
  90474 immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure).  
Code 90474 is an add-on code for use with 90743, and designates each additional vaccine beyond the first administered by intranasal or oral route.
 
A physician fee schedule for 2002 has not yet been made available, so reimbursement for the new codes is not known.  
Vaccines/Toxoids, Infusions and Pulmonary Testing  
Code 90732 has been revised to indicate that it is to be used only in patients over the age of 2 years:
  90732 pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use.
  Note: Generally, 90669 (pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use), which was revised in 2001, is appropriate for the youngest patients.    
Infusion [...]