Pulmonology Coding Alert

Question: A patient diagnosed with cystic fibrosis required intrapulmonary surfactant administration treatment. The pulmonologist intubated the patient and administered the surfactant into the lungs through the endotracheal tube. We reported 31500 and 94610-51 for the procedures, but the claim was denied.

How can we correct the claim?

Idaho Subscriber

Answer: You can correct the claim by reporting 31500 (Intubation, endotracheal, emergency procedure) and 94610 (Intrapulmonary surfactant administration by a physician or other qualified health care professional through endotracheal tube) without modifier 51 (Multiple procedures).

The error of your initial claim is the addition of modifier 51 on 94610. According to the CPT^® code set, 94610 is a modifier 51 exempt code, which means you cannot append modifier 51 to the code. Typically, you’d append modifier 51 to multiple procedure codes when the provider performs different related procedures on the same anatomic site during one session.

In your situation, the surfactant administration was part of the cystic fibrosis treatment, which required intubation of the patient. If the endotracheal tube was already present, then you should only report 94610.