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Pulmonology Coding Alert

CPT Update:

2002 Brings New and Revised Codes for Pulmonology

Published on Thu Nov 01, 2001

The CPT 2002 manual will be available in November 2001. An early release of new and revised codes by the AMA, however, has provided a preview of changes. Revisions affecting pulmonology are few and generally serve only to clarify or narrow previous definitions. In most cases, the revised descriptors do not affect the code application.
 
Although only time will tell how CMS and private payers will respond to the revisions and newly added codes, all physician offices should begin preparing now for the changes. CPT 2002 is officially effective Jan. 1, 2002, but not all payers adopt changes uniformly. Check with your carrier before billing any of the revised codes outlined below.
 

Bronchoscopy
 
Bronchoscopy code 31641 now includes the example of cryotherapy as an acceptable method of tumor destruction and relief of stenosis, but does not otherwise affect its use (new text has been bolded):
 
  • 31641 bronchoscopy, (rigid or flexible); with destruction of tumor or relief of stenosis by any method other than excision (e.g., laser therapy, cryotherapy).
    •  
    Cryotherapy (also known as cryocautery, cryosurgery or cryoconization) is a method of treatment that destroys abnormal tissue by freezing it. A probe is placed in contact with the tissue to be frozen. Nitrous oxide circulates through the probe, causing the tip to become extremely cold, about -89 C. The area to be treated is usually "frozen" twice, i.e., freeze, thaw, freeze, thaw.

    Immunization Administration
     
    Two new immunization codes have been added to report more precisely administration by intranasal or oral route. Code 90471, previously used for administration by percutaneous, intradermal, subcutaneous, intramuscular and jet injections, as well as by intranasal or oral route, has been revised to reflect the availability of the new codes.  
     
  • 90471 immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections); one vaccine (single or combination vaccine/toxoid)
     
  • 90473 immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
     
  • 90474 immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure).
    •  
    Code 90474 is an add-on code for use with 90743, and designates each additional vaccine beyond the first administered by intranasal or oral route.
     
    A physician fee schedule for 2002 has not yet been made available, so reimbursement for the new codes is not known.  

    Vaccines/Toxoids, Infusions and Pulmonary Testing
     
    Code 90732 has been revised to indicate that it is to be used only in patients over the age of 2 years:
     
  • 90732 pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use.
     
  • Note: Generally, 90669 (pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use), which was revised in 2001, is appropriate for the youngest patients.  
    •  
    Infusion code 90780 now drops the abbreviation "IV" for "intravenous":
     
  •   90780 intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour.
    •  
    This change does not alter application of the code, and physicians should continue to assign 90780 with caution. Specifically, documentation of physician presence during the infusion is required, says Carol Pohlig, BSN, RN, CPC, who works in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia. To meet the requirement for "direct" supervision, the physician must be present in the office suite (although not necessarily in the same room) and immediately available to offer instruction or assistance.
     
    Pulmonary test codes 94720 and 94750 drop the general language "any method" for more precise terminology:
     
  • 94720 carbon monoxide diffusing capacity (e.g., single breath, steady state)
     
  • 94750 pulmonary compliance study (e.g., plethysmography, volume and pressure measurements).

    • Allergen Immunotherapy
     
    For clarification, immunotherapy codes 95144, 95145 and 95165 now specify "supervision of preparation" of antigens rather than simply "supervision" of antigens. For the same reason, "single or multiple antigens" has been eliminated from the descriptors for 95144 and 95145.
     
  • 95144 professional services for the supervision of preparation and provision of antigens for allergen immunotherapy;  single dose vial(s) (specify number of vials)
     
  • 95145 professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom
     
  • 95165 professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses).
    •  
    As in the past, 95144 should be billed only if the antigen is to be injected by a physician other than the doctor who supervised its preparation, e.g., a primary care physician gives the patient an injection using an antigen provided by an allergist, says Walter O'Donohue, MD, FCCP, FACP, chairman of the CPT committee of the American College of Chest Physicians (ACCP) and a representative to the AMA CPT advisory committee for ACCP. Single-dose vials cost more than multiple-dose vials (95165) and should be used only to ensure proper dosage for injections. Allergists who prepare antigens are assumed to be capable of providing the appropriate dosage from the cheaper multiple-dose vials.
     
    The more precise term "equine serum" has replaced "horse serum" in the descriptor for 95180:
     
  • 95180 rapid desensitization procedure, each hour (e.g., insulin, penicillin, equine serum).

    • Care Plan Oversight
     
    The descriptors for care plan oversight (99374-99379) have been revised to clarify with whom the physician may coordinate care:
     
  • 99374 physician supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (e.g., Alzheimer's facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), and surrogate decision maker(s), e.g., legal guardian(s) and/or key caregiver(s) involved in patient's care; integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes.
     
    The codes for hospice and nursing-facility patients (99377 and 99379) have been similarly revised.

    • New "Home Care" Codes
     
    Several new home care codes, many of which should be of use to pulmonologists, have been added:
     
  • 99503 home visit for respiratory therapy care (e.g., bronchodilator, oxygen therapy, respiratory assessment, apnea evaluation)
     
  • 99504 home visit for patients receiving mechanical ventilation
     
  • 99539 unlisted home visit service or procedure.
    •  
    In addition, 99508 (home visit for polysomnography and sleep studies), which has also been added to CPT 2002, may be useful for sleep specialists included in pulmonary practices.
     
    Precisely how these codes will be applied, the reimbursement they will allow and whether CMS and private payers will accept them remains to be seen. Pohlig predicts that these codes will be billable if a physician or nonphysician practitioner (NPP) billing independently performs the service, but would not be billable under "incident to" guidelines if an NPP uses a physician provider identification number and that physician is not present when the service is performed. 

    Modifiers
     
    Only two modifiers have been changed. Modifier -60 (altered surgical field) was introduced in CPT 2001. At that time, the full descriptor for modifier -22 (unusual procedural services) in Appendix A of CPT was revised to state, "This modifier is not to be used to report procedure(s) complicated by adhesion formation, scarring, and or alteration of normal landmarks due to late effects of prior surgery, irradiation, injection, very low weight (i.e., neonates and infants less than 10 kg) or trauma."  However, in a Dec. 21, 2000, transmittal (B-00-75), CMS refused to recognize modifier -60, claiming that it lent itself to abuse and was difficult to verify. With that decision, modifier -22 again became appropriate to report the above-listed conditions.
     
    For 2002, modifier -60 has been deleted and the full descriptor for -22 has been revised. In practice, these changes do not alter CMS policy. Continue to apply modifier -22 for services greater than those usually required for the service/procedure to which it is appended (including cases of an altered surgical field, when appropriate), O'Donohue says. As before, careful documentation and a request for additional compensation commensurate with the additional effort and/or time necessary to complete the service or procedure are required, e.g., a 30 percent fee increase for a procedure that required 30 percent additional time or effort. Be sure to file a "paper" claim when reporting modifier -22, Pohlig says. The insurer will want to review the medical record.
     
    Note: All physician practices are strongly encouraged to purchase an updated CPT manual. For more infor-mation on all editions of CPT, as well as HCPCS and ICD-9 manuals, contact the AMA at (800) 621-8335 or visit the association's product Web site at www.ama-assn.org/catalog.

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