Pulmonology Coding Alert

NCCI also adds a 'standard' bundling edit between the new codes and spirometry code 94060

CPT added several new injection codes in 2006, and the National Correct Coding Initiative was ready to limit how you can use them by stating that you won't be able to report the new codes with most pulmonology services and procedures. Good news: You'll be able to use a modifier to unbundle some of the code pairs that took effect Jan. 1.

NCCI Creates Bundles You Were Already Expecting

When your pulmonologist administers a drug and performs a procedure such as a chest tube insertion, you won't be able to report both services. The newest set of NCCI edits bundles the following drug administration codes with most column 1 pulmonary system codes, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta:

• 90760--Intravenous infusion, hydration; initial, up to 1 hour

• 90765--Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

• 90772--Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

• 90774--... intravenous push, single or initial substance/drug

• +90775--...each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure).

NCCI bundles these injection codes into the procedure codes for bronchoscopies (31622-31656), thoracentesis (32000, 32002), pleurodesis (32005), insertion of chest tubes (32019, 32020) and starting an IV (36000). While the injection code bundles are significant and important because they limit the reimbursement you'll see on the new drug administration codes, the edits were expected, coding experts say.

Pay Attention to the Modifier Indicator

In most cases, you also won't be able to report an E/M service in addition to the new hydration and injection codes, Plummer says. NCCI 12.0 bundles almost all E/M services codes, such as new patient office visits (99201-99205) and established patient office visits (99211-99215), with 90760-90774.

Most of the drug administration bundles have a modifier indicator of "1," so in certain circumstances you can break the bundle using a modifier and report both CPT codes.

One notable exception is that the bundles between 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) and the injection codes (90760-90774) have a modifier indicator of "0." This means you can't report both the level-one established patient office visit with 90760-90774. Traditionally, Medicare includes the RVUs for 99211 in the RVUs associated with drug administration codes, so you would be double-dipping if you reported both services.

Avoid Reporting Injection Codes With 94060

NCCI bundles these new CPT injection codes into procedure code 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration). "This bundle should present few problems for pulmonary coders since it is difficult to imagine the necessity of using an infusion code while a patient is performing spirometry," Plummer says.

This is a standard edit that has been in place for the previously used infusion codes. Pulmonologists and coders will not have to adjust their billing methods, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

In addition: You should also note that NCCI bundles C8950 (Intravenous infusion for therapy/diagnosis; up to 1 hour) and C8952 (Therapeutic, prophylactic or diagnostic injection; intravenous push) with many pulmonology and E/M service codes when the facility reports these services through the Outpatient Prospective Payment System (OPPS).