Pulmonology Coding Alert

Before you report a thoracentesis procedure in 2008, be sure to check out a copy of the latest CPT manual.

Why? The old code set for the procedure is gone, and reporting the old codes rather than the new ones will lead to claim denial.

The AMA has released its list of codes that are slated to appear in CPT 2008, and it includes an overhaul of the thoracentesis code section, as well as two codes for smoking cessation counseling.

The possibility of last-minute edits to the code book is always possible, but you can probably look forward to implementing these CPT changes for Jan. 1. (Look to future editions of Pulmonology Coding Alert for possible changes to the current CPT 2008 code list.)

As Alan L. Plummer, MD, at Emory University School of Medicine in Atlanta told Pulmonology Coding Alert in vol. 8 issue no. 10, two smoking cessation codes that were previously only for Medicare patients will become CPT standards.

The AMA converted both G0375 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and G0376 (... intensive, greater than 10 minutes) to CPT codes, which will be available Jan. 1.

Time's on your side: These new codes are time-based, meaning you will not have to determine the level of service based on the complexity of the counseling. The new codes are:

• 99406 -- Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

• 99407 --... intensive, greater than 10 minutes.

(Note: We'll be tracking 99406-99407 claims in early 2008 to see how they work in practice; look for more information on payer response to these codes as it becomes available.)

Coders will want to pay attention to changes to the following thoracentesis, pleurodesis and chest tube insertion codes because they are used frequently in pulmonology practices, Plummer says. Check out this breakdown of the new codes.

Deleted: 32000 -- Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent

Added: 32421 -- Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent

Impact: The 32421 code is identical to the 32000 code. Just be sure to report 32421 instead of 32000 starting in January.

Deleted: 32002 -- Thoracentesis with insertion of tube with or without water seal (e.g., for pneumothorax) (separate procedure)

Added: 32422 -- Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure)

Impact: The 32422 code is nearly identical to the 32002 code and includes a water seal, if used. Just be sure to report 32422 instead of 32002 starting in January. The change in language -- from "with or without water seal" to "includes water seal" -- makes for more accurate coding, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Deleted: 32005 -- Chemical pleurodesis (e.g., for recurrent or persistent pneumothorax)

Added: 32560 -- Chemical pleurodesis (e.g., for recurrent or persistent pneumothorax)

Impact: The 32560 code is identical to the 32005 code. Report 32560 instead of 32005 starting in January.

Deleted: 32019 -- Insertion of indwelling tunneled pleural catheter with cuff

Added: 32550 -- Insertion of indwelling tunneled pleural catheter with cuff

Impact: The 32550 code is identical to the 32019 code. Report 32550 instead of 32019 starting in January.

Deleted: 32020 -- Tube thoracostomy with or without water seal (e.g., for abscess, hemothorax, empyema) (separate procedure)

Added: 32551 -- Tube thoracostomy, includes water seal (e.g., for abscess, hemothorax, empyema), when performed (separate procedure)

Impact: The 32551 code includes water seal. But this change was mostly to tighten up coding for the procedure, because a water seal is almost always used during a chest tube insertion, Plummer says.

If figuring the level of service for telephone E/Ms has made you reluctant to file the codes, CPT 2008 has some great news.

The latest version of CPT deletes 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...) and offers you a much simpler method for coding, as well as some specific nonphysician counseling codes.

CPT will roll out three new codes for telephone E/M care in 2008.

Deleted: CPT codes 99371-99373.

Added: The following CPT codes:

Benefit: Codes 99371-99373 required you to decide if the call is simple/brief, intermediate or complex. Now, all you'll have to do is find total encounter time and pick a code based on that. You may also have more guidance on which phone calls you should include as part of an E/M service and which you should separately report.

This is good news for coders -- if insurers jump on board with the new code.

The time-based phone codes "may help, if the payers reimburse these codes. However, just because there are codes does not mean a payer will pay," says Quinten Buechner, ACS-FP/GI/PEDS, CPC, CCP, CMSCS, president of ProActive Consultants in Cumberland, Wis.

"Insurers may bundle [the service] or just refuse to pay; Medicare will want evidence of face-to-face [service] unless it specifically adopts these codes for payment," Buechner says.

But that should not deter coders from reporting 99441, 99442 or 99443, experts say. These codes are "a step in the right direction for telemedicine, and I would encourage coders to use these codes until they are instructed by a carrier not to," says Kathy Pride, CPC, CCS-P, director of government program services for QuadraMed in Reston, Va.

Coders should check with their physicians as to whether or not to report these codes, Pohlig says. "Coding for services that are not payable by the insurer may have a negative impact on the patient. Beware of any out-of-pocket expenses for patients who may consider these services to be covered," she says.