Pulmonology Coding Alert

New codes on PFT, wheeze rating, and bronchial valve take the stage in 2011.

Brace yourself for a new wave of Category III codes affecting pulmonology coders, going into effect Jan. 1...

Background: Category III codes first came up in 2001 when the American Medical Association (AMA) saw the need for a systematic means of establishing specific codes for new procedures and technologies that do not meet the criteria for Category I CPT codes. They are temporary 5-year codes expected to be converted to a fullblown Category I code within this period.

Hint: You would usually be able to identify Category III codes with their format of four numbers followed by the letter T (e.g., 0177T). Thus, they are sometimes called "T" codes.

Bronchial Valve Codes Make A Debut

Three new codes affecting bronchial valve procedures (insertion or removal) describe emerging technologies, including:

• 0250T -- Airway sizing and insertion of bronchial valve(s), each lobe (List separately in addition to code for primary procedure;
• 0251T -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe; and
• 0252T -- ... with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure).

Guideline: You should use 0250T in conjunction with 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnosis, with cell washing, when performed [separate procedure]), and 31634. Why? "It's an add-on code for inserting a bronchial valve into a lobe," says Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta. He adds that 0250T has to be coded with one of the bronchoscopy codes, usually 31622, as it cannot be used by itself.

Example: A patient with a persistent leak through a chest tube (a bronchopleural fistula) undergoes bronchoscopy to find the leak after which a valve is inserted into the airway stopping the leak. You would code this 31622 for the bronchoscopy and 0250T for insertion of the bronchial valve. Keep in mind,however, that you will not get any reimbursement for 0250T, or any tracking code.

Meanwhile, you should never report 0251T in conjunction with endoscopy procedures 31622-31626, 31628-31631, 31634- 31636, 31638-31646. Code 0251T is a complete bronchoscopy code and includes 31622. The purpose of bronchoscopy is only to remove a bronchial valve which had been placed into the airway previously, says Plummer. That's why you cannot report 0251T with the other bronchoscopy codes.

Example: A patient with a persistent airleak had previously had a bronchial valve placed bronchoscopically which stopped the leak. The patient undergoes bronchoscopy to remove the valve. You would code this 0251T. If the patient had had several valves placed in two lobes that were removed at the same time, then the coding would be 0251T, 0252T for the removal valves from 2 lobes. It would be 0251T, 0252X2 if valves were removed from 3 separate lobes.

Wheeze Rating T Codes Emerge for PFT

Two of the more important Category III codes coming up next year concern acoustic pulmonary function test (PFT): 0243T (Intermittent measurement of wheeze rate for bronchodilator or bronchial-challenge diagnostic evaluation(s), with interpretation and report), and 0244T (Continuous measurement of wheeze rate during treatment assessment or during sleep for documentation of nocturnal wheeze and cough for diagnostic evaluation 3 to 24 hours, with interpretation and report).

Guideline: You are not to report 0243T -- used once every 24 hours -- with 0244T for the same period.

CPT guidelines state that if CPT offers a Category III code for a particular service, you must go for that code instead of a Category I unlisted code. So keep up with more news about 2011 T codes at http://www.ama-assn.org/ama1/pub/upload/mm/362/cptcat3codes.pdf.