Pulmonology Coding Alert

Note the new bronchospasm and push-drug designation

The upcoming National Correct Coding Initiative 11.1 edits will have little effect on your pulmonology practices, but the 11.1 edits do include nonmutually exclusive designations for bronchospasm evaluations and push-drug administrations (column 2: G0351-G0354).

The new edits include code 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) in column 1 and push-drug administrations codes in column 2.

These designation mean that carriers bundle codes in column 2 into the codes in column 1. 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 (Distinct procedural service), coding experts say.

Significance: There are few instances in which a pulmonologist would administer push drugs during a bronchospasm evaluation, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy and Critical Care at Emory University School of Medicine in Atlanta.

Though rare, one instance in which this may arise, Plummer says, is if the pulmonologist develops a protocol to study the effect of intravenous bronchodilators on pulmonary function. In this case, you would report 94060 and the appropriate G code, depending on the number of drug administrations the pulmonologist gives.

To view the latest update, refer to the CMS Web site www.cms.hhs.gov/physicians/cciedits/default.asp.