Pulmonology Coding Alert
CMS Targets Injection Codes in Version 8.3
For pulmonologists, the most important revisions in Correct Coding Initiative (CCI) version 8.3 bundle injection codes into the surgical respiratory codes the physicians frequently use. Version 8.3 lists more than 54,000 code-pair additions (i.e., new edits) and only four deletions. This is more than three times as many additions as those included in version 8.2, which was released in July. The fourth-quarter revisions went into effect Oct. 1 and contain several changes that affect pulmonologists. Injections Bundled Into Surgery The most significant change in version 8.3 is that it now bundles many injection codes into respiratory surgical procedures, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist for the department of medicine at the University of Pennsylvania in Philadelphia. These procedures include bronchoscopy (31615-31656), thoracentesis (32000-32002) and chest tube insertion (32020). Each of these procedure codes now includes the following injection codes:
For example, a pulmonologist performs a bronchoscopy with biopsy (31625). Before beginning the procedure, he inserts a needle into the patient's vein (36000) and infuses (90780) her with midazolam (Versed) and/or a narcotic such as meperidine (Demerol) for conscious sedation. Under the new CCI edits, you would bill only 31625 because payment for 36000 and 90780 is now bundled into the bronchoscopy reimbursement, Pohlig says. Before CCI 8.3, you would not have billed these codes together because payers considered 36000 and 90780 part of 31625, she adds. "This new edit brings the CCI more in line with current practices." Report Drug Supply Separately Although the injections may now be bundled into the surgical procedures, the supply for the material injected is not. You may still report that separately using the appropriate HCPCS code in addition to the surgery code when the procedure is performed in the office. If the pulmonologist performs the procedure in the hospital, the facility will bill for the drug supply.
Similarly, CCI version 8.3 has bundled injection code 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) into allergen immunotherapy codes 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 ( two or more injections). And spirometry code 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) now includes 36410 and 90780.
You can attain a copy of the CCI edits from the National Technical Information Service on the Web at www.ntis.gov or by calling 1-800-363-2068.
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