Avoid Mistake when Coding Lung Volume Reduction Surgeries

Billing for lung volume reduction surgery (LVRS) can get you payments as much as $1,441; however your coding has to be accurate to ensure payments.

LVRS is sometimes called reduction pneumoplasty (RP). It calls for an all-encompassing team approach that can only be delivered by an experienced team of thoracic surgeons, pulmonologists, anesthesiologists, and nurses who have specialization in complex lung disease.

Read the following coding tips for pulmonary practice and turn the situation in your favor.

Applying modifier 50 could mean trouble

The code for lung volume reduction is 32491. The issue of unilateral or bilateral surgery doesn’t apply on 32491 as you should assign 32491, irrespective of whether the thoracic surgeon carries out the procedure on one lung or two.

As such, there’s no need for modifier 50 to indicate a bilateral procedure or modifier 52 to reflect a unilateral procedure for a code that’s considered inherently bilateral.

If your documentation is lacking, you should prove medically necessity

Many payers cover LVRS, particularly for chronic obstructive pulmonary disease with underlying severe emphysema. In order to be able to show 32491’s medical necessity, you should meet some medical guidelines, which differs from payer to payer. Nevertheless, the medical world agrees that a candidate for LVRS should have severe emphysema, disabling dyspnea and evidence of severe air trapping.

See to it that you include G codes

The surgery must be preceded and followed by a program of diagnostic and therapeutic services consistent with those provided in the National Emphysema Treatment Trial (NETT) and designed to maximize the patient’s potential to undergo and recover from surgery successfully.

The program must cover a 6- to 10-week series of at least 16, and no more than 20 preoperative sessions, each lasting for a minimum of two hours. It must also include at least 6 and not more than 10, postoperative sessions, each lasting a minimum of two hours, within eight to nine weeks of the LVRS.

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