Pulmonology Coding Alert

Test yourself with these 5 questions about the edits, deletions, and additions

If you’re still trying to get a grip on the changes from the Jan. 1 CPT changes, take this quiz. These questions will test just how well you understand the new conscious sedation and drug administration changes.  Look below the article to see the answers.

Question 1: A 2-year-old patient undergoes a bronchoscopy. To minimize the child’s emotional trauma and to ensure complete safety during the procedure, your pulmonologist administers moderate sedation. How should you report this?

A. 31622
B. 31622 and 99143
C. 31622 and 99144
D. 31622 and +99145

Question 2: True or false: You can never report conscious sedation with tube thoracostomy (32019, 32020).

Question 3: An internist requests that your pulmonologist see a newly hospitalized patient with chronic obstructive bronchitis and a new right lower lobe (RLL) infiltrate accompanied by fever, cough and yellow sputum. The pulmonologist diagnoses pneumonia and on a different day during the same inpatient stay he checks on the patient and provides subsequent pulmonary care. Which of the following coding scenarios might be appropriate for reporting these visits in 2006?

A. 99253 for the first visit and 99261 for the second
B. 99261 for the first visit and 99231 for the second
C. 99253 for the first visit and 99231 for the second
D. None of the above

Question 4: A patient has an acute asthma attack and your pulmonologist orders an IV push of SoluMedrol. What code should you use?

A. 90782
B. 90774
C. 90784
D. G0344

Question 5: A patient receives a subcutaneous injection of omalizumab (Xolair) under direct supervision of the physician. How should you report this using the new codes?

A. 99211
B. 99211 and J2357
C. 90772
D. 90772 and J2357

Quick Quiz Answers

Answer 1: A. You should report just the bronchoscopy procedure code, 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]). Code 99143 (Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedations support, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; under 5 years of age, first 30 minutes intra-service time) would be the appropriate conscious sedation (CS) code, but you’re not allowed to report CS with 31622. Code 31622 is a “targeted” code, according to Appendix G of CPT. This means that if the same physician performs the bronchoscopy procedure and provides the CS, you cannot bill for both.

Answer 2: False. You may be able to report 99148-99150 for CS during a targeted procedure, according to instructions in CPT Changes 2006: An Insider’s View, but the service must meet two requirements.

1. As required by the code descriptors, a second physician (not the physician providing the service that supports the CS) must provide the sedation.

2. The targeted procedure and the CS must take place in a facility setting (such as a hospital or outpatient hospital/ambulatory surgery center).

Answer 3: C. Given the appropriate levels of service, 99253 (Initial inpatient consultation for a new or established patient…) and 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient…) would be appropriate codes for the scenario given. CPT 2006 deleted follow-up consultation codes 99261-99263 (Follow-up inpatient consultation for an established patient …). You should now report initial consultations in the inpatient setting using 99251-99255, and follow-up inpatient consultations or subsequent hospital care using subsequent hospital care codes 99231-99233.

Answer 4: B. When a patient is having an acute asthma episode and the physician orders an IV push of SoluMedrol, you should report this type of service using 90774 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug) for the initial infusion and +90775 (… each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]) if the pulmonologist uses the same method to administer additional medication. In 2005, you had to use codes 90782-90784 for private payers, or temporary G codes G0344-G0358 for Medicare, to report drug administration services. CPT deletes 90782-90784 for 2006 and offers nine new drug administration codes that you should submit to both commercial and Medicare insurers.

Answer 5: D. If a patient receives a subcutaneous injection of Xolair under direct supervision of the physician, report 90772 (Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). If, however, there is no direct physician supervision, CPT directs coders to report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) instead of 90772. You should also report J2357 (Injection, omalizumab, 5 mg) for each 5 mg of Xolair given. Note that certain insurers also require direct physician supervision in order to report 99211 as well.

Good idea: For more information on the CPT 2006 changes that affect pulmonology practices, check out the January 2006 issue.

Answers reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.