Master 32561’s guidelines to prevent a major units gaffe.
Flip through the Surgery/Respiratory System section of your CPT 2010 manual, and you’ll see the coding committee has been hard at work adding to and revising your options. Discover the added cath removal code, the all new fibrinolytic agent instillation code, and the reshaped bronchoscopy descriptors, so you can rest assured your coding will be ship-shape in 2010.
1. End Your Hunt for 32550’s Removal Code Match
Until now, CPT has offered insertion code 32550 (Insertion of indwelling tunneled pleural catheter with cuff), but you’ve been left in the lurch for removal, using either an E/M or unlisted code.
CPT 2010 adds new code 32552 (Removal of indwelling tunneled pleural catheter with cuff) to solve this problem, said Stephen Hoffman, MD, associate professor of clinical medicine at Ohio State University Medical Center in Columbus and AMA CPT Advisory Committee American Thoracic Society representative, at AMA’s 2010 annual CPT and RBRVS symposium.
Tube trivia: “Initially, when code 32550 was created, an indwelling tunneled pleural catheter with cuff was inserted for drainage and management of malignant pleural effusions at the end of a patient’s life; therefore, the removal of the catheter was not included in the valuation of 32550,” according to The ACR’s Radiology Coding Source (Sept./Oct. 2009).
Code 32552 now covers the incisions and “subcutaneous dissection of the indwelling cuff” needed to remove the catheter, ACR explains.
Next, watch out for the coding pitfall …
2. Don’t Fall for Multiple 32561 Unit Temptation
CPT 2010 also adds two new codes to describe instilling a fibrinolytic agent. Note that CPT divides them based on initial and subsequent day:
• 32561 – Instillation(s), via chest tube/catheter, agent for fibrinolysis (e.g., fibrinolytic agent for break up of multiloculated effusion); initial day
• 32562 – … subsequent day.
Key point: Limit your 32561 coding to once on the initial day, and limit 32562 to one unit on each subsequent treatment day, according to CPT guidelines. This rule holds true even if the physician instills a fibrinolytic agent multiple times during the day. If you’re having trouble getting the units right, take a few minutes to create a reminder for yourself. You can go high-tech (coding software) or low-tech (sticky notes), says Cheryl A. Scott, CPC, CPC-H, CCS, CCS-P, a coding manager for HealthTexas.
These new 3256x codes led to an update of 32560’s descriptor:
• 2009: 32560 – Chemical pleurodesis (e.g., for recurrent or persistent pneumothorax)
• 2010: 32560 – Instillation, via chest tube/catheter, agent for pleurodesis (e.g., talc for recurrent or persistent pneumothorax).
Rationale: The descriptor change clarifies that code 32560 applies to agent instillation for pleurodesis. In contrast, 32561 and 32562 are specific to agent instillation for fibrinolysis.
3. Remember Bronchoscopy Codes Include Fluoro
CPT’s respiratory system underwent a few other changes you should be aware of. A small wording change clarifies that 31622-31656:
• are appropriate whether or not the provider uses fluoroscopic guidance
• include fluoroscopic guidance, so you should not report fluoro separately.
31622-31640: You’ll see a minor rephrasing for this code range:
• 2009: 31622-31640 – Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance …
• 2010: 31622-31640 – Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed …
31641-31656: Additional wording revisions change
the root descriptor for 31641-31656 so that it now matches 31622-31640:
• 2009: 31641-31656 – Bronchoscopy, rigid or flexible …
• 2010: 31641-31656 – Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed …
CPT 2009 guidelines already had instructed that 31622-31646 included fluoro when performed and CPT 2010 includes this guideline, as well.
New code alert: Among these revised codes are two new codes. First is 31626 (… with placement of fiducial markers, single or multiple), said Scott Manaker, MD, PhD, physician at the University of Pennsylvania and AMA RUC American College of Chest Physicians (ACCP) representative, at the AMA symposium.
If your practice bears the cost of the markers, you may report them separately. (For information on other marker placement codes, see “Call on 32553 and 49411 for Fiducial Marker Placement in 2010″ on page 117.)
The second new code is +31627 (… with computerassisted, image-guided navigation [List separately in addition to code for primary procedure(s)]), which is an add-on code. Be sure you report it alongside only the codes CPT specifies:
• 31615 ” Tracheobronchoscopy …
• 31622-31631
• 31635
• 31638-31643.
And because +31627 includes 3D reconstruction, you should not report 76376-76377 (3D rendering …) together with this code, the guidelines state.
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