CCI Edits 17.3: 32422, 71010 Bundle -- And More -- Enhance Your Pulmonary Coding Options

Immunotherapy code Q2043 is anot an area of concern for pulmonologists, and should be an oncology issue.

The most recent Correct Coding Initiative (CCI) edits bundle chest radiologic guidance along with numerous procedures on the lungs and pleura, and even though CCI edits 17.3 assemble immunotherapy code Q2043 with lots of ventilation and gas procedures, you must not worry -- here's why. Read this article for accurate medical coding.

Establish Chest X-ray Distinctness From Thoracentesis To Ignore Bundle

For the newest CCI edits version, you must keep an eye on bundled chest x-rays as well as chest tube procedures. Particularly, both 71010 (Radiologic examination, chest; single view, frontal) along with71020 (Radiologic examination, chest, 2 views, frontal and lateral) become parts of:

32422 – {Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure)}

32550 – {Insertion of indwelling tunneled pleural catheter with cuff}

32551 – {Tube thoracostomy, includes water seal (e.g., for abscess, hemothorax, empyema), when performed (separate procedure)}

93503 – {Insertion and placement of flow directed catheter (e.g., Swan-Ganz) for monitoring purposes.}

CCI edits mention the motive for the bundle as wrongly using column two code with column one code. These CCI edits have a modifier indicator of "1", consequently you may overrule the edits with a modifier (i.e., modifier 59, Distinct procedural service) on the column 2 code when the services are different.

Example: A patient with COPD (490-496) gets admitted with shortness of breath (786.05) along with chest pain (786.5), deteriorating with inspiration. A chest x-ray (71010) prove pneumothorax (512.x) and the patient must go through thoracentesis with insertion of tube (32422) to get rid of the excess air and let the lung re-expansion. In this sceanrio, you would report 32422, 71010-59 to point out that the chest x-ray was different from the thoracentesis.

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Take note: Pulmonary specific guidelines preside over the abovementioned Column 1 codes. For example when coding 32422, you must consider a dissimilar radiologic guidance code for catheter placement/confirmation (e.g., 76942, 77002, 77012), which more precisely reflects the service description, method as well as service time linked with the procedural guidance provided.

The similar guidelines are applicable to 32550-32551. In other words, you must consider code 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation) to signify radiologic guidance for catheter placement/confirmation.

Medical Coding Tip: Remember that you must use 71010 and 71020 simply for radiologic examination of the chest, and not to assist or substantiate needle placement.