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Pulmonology Coding Alert

NCCI Update:

NCCI 11.0 Edits Will Change Your 31622 Reporting

Published on Sun Jan 02, 2005

12 new bundles shed new light on appending modifier -59 to bronchoscopy codes in 2005

When your pulmonologist performs bronchoscopy, thoracentesis, chemical pleurodesis, or tube thoracostomy procedures, you may find yourself jumping through hoops to collect payment when the procedures involve infants or stent placements.

The National Correct Coding Initiative's (NCCI) latest version (11.0), effective Jan. 1, includes 12 new bundles that you should pipe down and take notice of, before your bottom line pays the penalty.

'1' Is the Only Number When It Comes To Bundling or Unbundling

NCCI contains two types of edits: mutually exclusive and "column 1/column 2" (previously known as "comprehensive/component" edits).

Mutually exclusive edits pair procedures or services that the physician could not reasonably perform at the same session on the same beneficiary, says Kelly Dennis, CPC, EFPM, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla.

The new edits include codes in column 2 that carriers bundle into the codes in column 1. These are non-mutually exclusive codes with a '1' in the modifier column.

Exception: An indicator of "1" means that you may use a modifier to override the edit if the procedures are distinct from one another. This means that if the procedure in column 1 occurs at a different location than the procedure in column 2, you may report the services independently with modifier -59, coding experts explain.

  •  Column 1: Anesthesia code 00561 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest;...with pump oxygenator, under one year of age).

  • Column 2: Codes 31622 (Bronchscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]) and 31645 (...with therapeutic aspiration of tracheobronchial tree, initial [eg, drainage of lung abscess]).
     
  • Column 1: The new CPT bronchoscopy code 31636 (Bronchscopy, rigid or flexible, with or without fluoroscopic guidance).
     
  • Column 2: 31622 and 31630 (...with tracheal or bronchial dilation or closed reduction or fracture).

  • Column 1: The new CPT bronchoscopy code 31638 (...with placement of bronchial stent[s] [includes tracheal/bronchial dilation as required], initial bronchus).

  • Column 2: 31622 and 31630

  • Column 1: The new CPT incision code 32019 (Insertion of indwelling tunneled pleural catheter with cuff).

  • Column 2: 32000 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent), 32005, (Chemical pleurodesis [eg, for recurrent or persistent pneumothorax]) and 32020 (Tube thoracostomy with or without water seal [eg, for abscess, hemothorax, empyema] [separate procedure]).

    Warning: You must append modifier -59 (Distinct procedural service) to the column 2 code to indicate to the payer that the billed procedures are distinct and separately identifiable, says Beth Glenn, CPC, CMA, certified coder for Jefferson Physicians in Jefferson City, Tenn. "Without modifier -59, the payer will simply apply the NCCI edits and deny payment," she says.

    NCCI Adds a New Level of Specificity to 31622

    The edits for codes 31636 and 32019 should have little impact, says Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy and critical care at the Emory University School of Medicine in Atlanta, Ga.

    Warning: Don't use 31622 for bronchcoscopy with stent placement with any of the other bronchoscopy codes, Plummer explains.

    Example: If the patient requires a tracheal stent placement as well as a bronchial stent, you should report 31630 with modifier-59 to indicate that the pulmonologist placed stents in separate areas of the airways.

    Reporting 31638 includes replacement of a tracheal stent during the procedure, so you shouldn't report 31630, Plummer says.

    Specific Cath Placements and Thoracentesis Might Not Mix

    If the physician places an indwelling tunneled pleural catheter with cuff, you should report catheter placement code 32019, which would preclude coding for a thoracentesis, 32000, at the same setting, Plummer says.
     
    Explanation: A pulmonologist places a tunneled, indwelling cuffed catheter in place of a tube thoracostomy, 32020, to drain the pleural space of the patient's chest cavity.
     
    However, if the pulmonologist sees signs of bilateral pleural effusions, the pulmonologist may place a tunneled cuffed catheter on one side of the patient's lung and a thoracentesis on the opposite side, Plummer says.

    In such a case, you should append modifier-59 to indicate that the pulmonologist performed a separate procedure in addition to the tunneled, cuffed catheter insertion, 32019, Plummer says. 

    For a pulmonologist to place a tube thoracostomy, 32020, in the opposite pleural space of the patient's lung or chest cavity after he inserts a tunneled, cuffed catheter would be highly unlikely, Plummer explains.
       
    Editor's note: To view the latest update, refer to the CMS Web site     www.cms.hhs.gov/physicians/cciedits/default.asp.

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