Pulmonology Coding Alert

None of the deletions affect your pulmonology coding

The latest National Correct Coding Initiative edits, version 11.3, which go into effect Oct. 1, will bundle diagnostic laryngoscopy into three other laryngoscopy procedure codes.

Watch for '0' Modifier Indicators

The update bundles 31525 (Laryngoscopy, direct, with or without tracheoscopy; diagnostic, except newborn) into 31527 (... with insertion of obturator), 31528 (... with dilation, initial), and 31529 (... with dilation, subsequent).

These three bundles have a modifier indicator of "0," which means you cannot unbundle the codes under any circumstances. You can never report both codes for the same patient on the same day.

These new edits reflect the standards of medical/surgical practice and are consistent with CPT bronchoscopic guidelines in that "surgical" services include "diagnostic" services, pulmonology coding experts say. In other words, before the physician can perform an intervention (e.g., dilation), he must view the area to select the problematic location.
 
You may not see a huge effect to your pulmonology practice's reimbursement. "As it is now, billing these codes together does not generally reimburse a whole lot more," says Denae M. Merrill, CPC, coder for NEM Pulmonary Associates in Saginaw, Mich. "Since these codes are in the same 'family,' the allowed amount for the base code is taken out of the payment for any codes after the first one, and the reimbursement for the additional codes ends up being a couple dollars or even less. And there are some commercial carriers, I'm sure, who already have this as an internal policy and haven't been paying for more than one for a while."

The main difference is that these NCCI edits require that you submit only one code for payment when the physician has provided more than one service. "For statistical purposes, one may have to consider whether or not they want to continue to charge out, with a zero billed amount, everything performed or bill only the highest RVU of all services performed," Merrill says.

You Can Use Modifier 59 in Some Cases

NCCI version 11.3 also bundles 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]) into 31600 (Tracheostomy, planned  [separate procedure]).
 
This bundle, however, has a "1" in the modifier column. This indicates that you can append modifier 59 (Distinct procedural service) to unbundle these procedures, as long as it is medically necessary to provide each service, and your documentation supports two separate services (e.g., when the pulmonologist performs a bronchoscopy on the patient earlier in the day).

"While a bronchoscopy would not be routinely done for every patient who gets a tracheostomy, this will affect the special-circumstances cases," Merrill says. Per CPT, bronchoscopy requires insertion of a rigid or flexible bronchoscope through the oropharynx, vocal cords and beyond the trachea into the right/left bronchi.

It is unlikely that a pulmonologist will perform a bronchoscopy on the same day, subsequent to a tracheostomy, coding experts say. But on the infrequent occasion that the physician performs a bronchoscopy prior to a tracheostomy (e.g., earlier in the day), report both services with modifier 59 attached to 31622.

Note: To view the latest update, go online to www.cms.hhs.gov/physicians/cciedits/default.asp.