Pulmonology Coding Alert

Plus : Forget what you know about coding pulmonary stress testing.

Although the ink is barely dry on the new ICD-10 codes that your practice recently put into place, it's time to get to know another new set of codes, thanks to the release of CPT® 2018. Jan. 1 will be here sooner than you think, so get to know these six major updates now to prepare you pulmonary practice for the latest code set.

1. Chest X-Ray Section Gets Big Makeover

When CMS released its 2018 proposed Medicare Physician Fee Schedule, pulmonology coders may have noticed that it listed four new chest x-ray codes. However, the proposal didn't indicate whether these new codes would replace existing ones or supplement then. Now, with the release of CPT^® 2018, it's clear that the new codes will replace the x-ray codes that many pulmonary care coders have committed to memory. The new chest x-ray codes are as follows:

• 71045 (Radiologic examination, chest; single view)
• 71046 (Radiologic examination, chest; 2 views)
• 71047 (Radiologic examination, chest; 3 views)
• 71048 (Radiologic examination, chest; 4 or more views)

Meanwhile, CPT^® has eliminated all of the existing chest x-ray codes from the 2018 manual. Everything in the 71010-71035 range will be deleted from CPT^® effective Jan. 1.

"It seems that the codes are being simplified based on the number of views in total, rather than the type of view (e.g., frontal and lateral [71020] vs lateral decubitus [71035]) or method (e.g., frontal and lateral with oblique projections [71022])," says Carol Pohlig BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania. "It will be interesting how they adjust the value to accommodate the simple and complex services being represented by the same code set," she said.

2. Find Updates for Pulmonary Stress Testing

You'll find big changes to diagnostic codes that pulmonologists use every day to describe pulmonary stress testing. Effective Jan. 1, CPT^® will no longer recognize existing code 94620 (Pulmonary stress testing; simple [eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]). Instead, you'll find two new codes in its place, as follows:

• 94617 (Exercise test for bronchospasm, including pre- and post-spirometry, electrocardiographic recording[s], and pulse oximetry)
• 94618 (Pulmonary stress testing [eg, 6-minute walk test], including measurement of heart rate, oximetry, and oxygen titration, when performed)

In essence, the services that were previously both included in 94620 are now separated out into their own services so insurers can value each separately. At this point, it is unclear whether these codes will be billable together, and if so, whether a modifier will be required.

You'll also find revisions to code 94621, as follows:

• Current descriptor: Pulmonary stress testing; complex (including measurements of CO2 production, O2 uptake, and electrocardiographic recordings)
• New descriptor effective Jan. 1: Cardiopulmonary exercise testing, including measurements of minute ventilation, CO2 production, O2 uptake, and electrocardiographic recordings

The previous options were cardiovascular stress testing, simple pulmonary stress testing, and complex pulmonary stress testing (combining the two types, in a sense), Pohlig explains. "Now with the clarification of the two simple testing types (exercise test for bronchospasm, and six-minute walk), the complex testing is further specified to indicate the cardiovascular component of the ECG recordings. Ordering physicians may be able to more easily identify the type of testing they really need (and prevent ordering of 93015 and 94621 together, as these are bundled together)," she said.

3. Find New Cryoablation Therapy Code

Coders will now have a Category I code to report cryoablation of a pulmonary tumor, thanks to the addition of 32994 (Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; cryoablation).

This code replaces existing Category III code 0340T (Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance).

Category III CPT^® codes are temporary codes that describe emerging technology, services and procedures. The primary purpose of these codes is to allow for data collection, which in turn provides information for evaluating the effectiveness of new technologies and the formation of public and private policy.

The designation of a Category III code is an important first step in wider adoption of new technology and the eventual creation of a Category I CPT^®  code to describe the service, which successful transpired in the case of pulmonary tumor cryoablation.

4. Check for Bronchoscopy Revisions

CPT^® will also make subtle changes to two bronchoscopy codes, which could impact your code selections, as follows:

• 31645 Current Descriptor: Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheo­bronchial tree, initial (eg, drainage of lung abscess)
• 31645 Effective Jan. 1: Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheo­bronchial tree, initial)
• 31646 Current Descriptor: Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheo­bronchial tree, subsequent
• 31646 Effective Jan. 1: Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheo­bronchial tree, subsequent, same hospital stay)

The biggest differences are that 31645 will remove the "eg, drainage of lung abscess" reference, and 31646 now clarifies that the subsequent bronchoscopy occurs during the same hospital stay.

5. Update Lab Test, Needle Introduction Codes

CPT^® 2018 will introduce two new lab codes that could impact pulmonology orders, as follows:

• 87634 (Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus, amplified probe technique)
• 87662 (Infectious agent detection by nucleic acid (DNA or RNA); Zika virus, amplified probe technique)

In addition, the latest version of CPT^® will update the descriptor for 36140 (Introduction of needle or intracatheter, upper or lower extremity artery). Although the code itself will remain the same, the new verbiage specifies that the code refers to either the upper or lower extremity artery. In the past, the descriptor simply referred to "extremity artery."

6. Subtle Language Change to Observation Codes 99217-99220

You have to look closely to notice, but the preamble to the "Initial Observation Care, New and Established Patient" section of CPT^® and the full code descriptors for 99217-99220 have the words "outpatient hospital" inserted before the term "observation status." For example, the passages now read as follows:

"The following codes are used to report the encounter(s) by the supervising physician or other qualified health care professional with the patient when designated as outpatient hospital 'observation status.'"

This appears to indicate observation services are only allowed in the hospital setting, whereas the presumption in the past was that observation was a "status" and not a defined place. That status is now limited to the outpatient hospital setting.

Keep an eye on Pulmonology Coding Alert as new directives are issued that shed additional light on how to report the new codes for 2018.