Pulmonology Coding Alert

Manufacturer, AMA differ on planning phase's correct coding choice.Be sure you have the full scoop on which unlisted procedure code you should use for the planning stage of electromagnetic navigational bronchoscopy (ENB).When reporting ENB, you should code separately for the treatment planning stage, the navigational portion of the procedure, and any biopsies, brushings, or needle aspirations your physician completes. CPT does not have a specific code for navigational bronchoscopy, which means you have to resort to "unlisted" codes for the planning and navigational stages.Be Aware of Differing OpinionsHearing differing instructions on which unlisted procedure code to use? The ENB system manufacturer recommends using 77299 (Unlisted procedure, therapeutic radiology clinical treatment planning) for the treatment planning stage, as reported in Pulmonology Coding Alert, Vol. 9, No. 9. The AMA's CPT Assistant, however, recommends 76499 (Unlisted diagnostic radiographic procedure) because "the appropriate bronchoscopy code would be reported for the surgical intervention performed subsequent to the preplanning by the use of the navigational software" (CPT Assistant, March 2008).Some coders automatically follow CPT Assistant's coding advice over the manufacturer's recommendation. Both are "unlisted" procedure codes, so discuss the options with your pulmonologist and ask his opinion before submitting your claims.Code the Other PortionsThe navigational portion of the procedure also does not have a CPT code, says Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta.Report this stage with 31899 (Unlisted procedure, trachea, bronchi).Submit the appropriate bronchoscopy code(s) for the biopsies, brushings, or needle aspirations. Your options include:• 31622 -- Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing (separate procedure)• +31633 -- ... with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure) • 31641-- Bronchoscopy (rigid or flexible); with destruction of tumor or relief of stenosis by any method other than excision (e.g., laser therapy, cryotherapy)• 31643 -- ... with placement of catheter(s) for intracavitary radioelement application.Rejoice in Pay With Proper NotesENB is a new technology, and more payers reimburse for the procedure on a case-by-case basis now than in the past. Because of this, it is critical for your pulmonologist to completely document what was done during the ENB, says Carol Pohlig, BSN, RN, CPC, ASC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.