Pulmonology Coding Alert

HCFA temporarily suspended a significant portion of the 6.3 national Correct Coding Initiative (CCI) edits that bundled 16 pulmonology procedure codes to evaluation and management (E/M) services. The announcement was made on Jan. 26, 2001, and the suspension is retroactive to Oct. 30, 2000, the effective date of the 6.3 edits. The suspension also includes any edit pairs that were continued in version 7.0, effective through March 31, 2001. HCFA is reviewing the edits, and a number of them may be re-implemented. But this would not occur before July 1 of this year.

A HCFA spokesperson said the agency would not comment on its reason for suspending the edits. Most significant about the 6.3 edits was the bundling of E/M services with diagnostic procedures a decision that took many physicians and coders by surprise, says Barbara Cobuzzi, CPC, CHBME, president of Cash Flow Solutions Inc., a medical consulting and billing company in Lakewood, N.J. The changes were not publicized adequately and placed a financial burden on doctors who suddenly were receiving denials for previously covered procedures, says Cobuzzi.

All xxx codes (with a global period of zero) have been unbundled. The following pulmonary lab procedure and interpretation codes are no longer bundled with E/M services:

94014-94015 (relating to patient-initiated spirometry)
94070 (prolonged postexposure evaluation of bronchospasm)
94620-94621 (pulmonary stress testing)
94640-94642 (inhalation treatments)
94650-94652 (intermittent positive pressure breathing [IPPB])
94660-94668 (continuous positive airway pressure ventilation [CPAP])

Pulmonary practices should consider reviewing denials received on the inclusive codes and resubmit relevant claims to their carriers. The carriers will not reprocess denied claims automatically. Any denied E/M services meeting the criteria of significant and separately identifiable should be resubmitted, and despite the suspended edits, modifier -25 should still be appended to the E/M service when submitting these claims together because it is considered correct coding to use the modifier to prove that the services were significant and separately identifiable.