Pulmonology Coding Alert

Pulmonologists emerge relatively unscathed as the Correct Coding Initiative (CCI) version 9.0 hits the shelves. The only pulmonology services affected are nerve block, allergy, and some E/M services. Therefore, until the next edits emerge, your coding will not change greatly.

Nerve Blocks Bundled in Pulmonology Procedures

Only in certain circumstances do pulmonologists use local anesthesia with their procedures, such as during a thoracentesis or pleural biopsy, says Brian Carlin, MD, assistant professor of medicine at Allegheny General Hospital, Pittsburgh. In any case, be aware that the new CCI bundles several nerve block codes (64416, 64420-64421) into most of the pulmonology procedures. For example, version 9.0 bundles 64416 (Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) with almost every procedure, whereas it includes 64420-64421 with tracheal procedures (31600-31615), bronchoscopies and catheter procedures (31622-31730), and thoraco-scopies (32601-32665).

"If they have bundled these codes, it is because they feel that the surgeon doing the procedure is capable of IV sedation," says Barbara Johnson, CPC, MPC, a professional coder with the Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif.

Pulmonologists usually use conscious sedation when there is any need for anesthesia, says Debbie Tiesmeyer, CPC, a practice coder at Deborah Heart & Lung Center in Browns Mills, N.J. Therefore, these edits simply reiterate a concept that is already understood. More than likely the pulmonary procedures are a part of an effort to bundle nerve blocks across the board.

Watch Out for Critical Care Bundles

The new CCI bundles many procedures into the new pediatric critical care (99293-99294) and low-birth-weight (99299) codes. These additional bundles keep the new codes in line with the established edits for other critical care codes: end-stage renal disease (ESRD) services (90918-90921), pulmonary function tests and ventilation management (94656-94657, 94660, 94760-94762), nervous system and behavioral assessments (96115, 96150-96155), endotracheal intubation (31500), needle/catheter placements and transfusions (36000, 36140, 36400-36406, 36420, 36430-36440, 36488, 36490, 36600, 36620, 36640), aspiration of bladder (51000), spinal puncture (62270), and G0272 (Naso/oro gastric tube placement, requiring physician's skill and fluoro-scopic guidance [including fluoroscopy, image documentation and report]).

There are some small changes of note in allergy test and E/M coding. The edits bundle Category III code 0010T (Tuberculosis test, cell mediated immunity measurement of gamma interferon antigen response) into several allergy test codes (95010-95044). According to Lisa Clifford, CPC, owner of the multispecialty coding firm Clifford Medical Billing Specialists in Naples, Fla., there is no obvious reason why this Category III code would cross the allergy test codes. She believes that these tests would usually be done separately, for different reasons, and probably not on the same day to be considered bundled.

Version 9.0 also bundles the new HCPCS code G0272 into all E/M service codes (99201-99440). In the Dec. 31, 2002, Federal Register, G0272 is indicated with an "X" status symbol, which means no payment can be made under the Physician Fee Schedule. Therefore, it must be bundled into the E/M codes.