Mike Nelson, MD, FCCP

Pulmonary physicians and particularly interventional bronchoscopists have been receiving denials when CPT^® codes 31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe and 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) are billed during the same procedure.

While the difference between a transbronchial forceps biopsy and transbronchial needle biopsy are obvious to bronchoscopists, there has been confusion with payers. This could have been partly on the basis of a CPT Assistant article from March 2021 describing the use of both codes that stated, “Note that performing two types of lung biopsy (forceps and needle aspiration) on the same lesion would be considered unusual and documentation of medical necessity should clearly describe why both types of biopsy were clinically necessary.” This may have been interpreted by coders and/or payers to mean that the two codes should be billed together rarely or not at all. It is also possible that computer-based coding programs (eg, Optum/Encoder Pro, etc) are responsible for these inappropriate denials. There are, however, no NCCI edits that disallow this nor was this the intent of the CPT codes when they were developed.

The previous statement from the CPT Assistant article was clarified in the following sentences, “For example, if needle aspiration were performed and immediate screening of the sample were insufficient for diagnosis, a forceps biopsy would be appropriate and reported separately. On the other hand, if a physician performed a needle aspiration out of concern that the lesion was vascular and found that it was not and proceeded with a forceps biopsy, then the needle aspiration would be integral to the forceps biopsy and not separately reported.” Importantly, with the increasing use of navigational bronchoscopy and robotic bronchoscopy, these codes will be used together more frequently, appropriately, and correctly, especially on distal lesions.

Remember, these codes are used for procedures in a single lobe. If multiple lobes are sampled then CPT codes 31632 and 31633 would be added to 31628 and 31629, respectively. If one is receiving denials for these procedures, coders and payers should be notified of these errors, and denials should be appealed.

Q&A

Question: My practice is wondering if we can use the newer codes for online digital E/M services? We know they are time-based, but we are confused about when they cannot be used. Can you please help? For example, I had an established COPD patient send a message through the electronic health record’s patient portal reporting new symptoms of headache, cough, and sputum production. They asked me to review the chest x-ray that was done two days prior when they went to urgent care. The patient is asking for an assessment and management plan. We message back and forth over the next day for a total of 13 minutes. Three days later, the patient developed more symptoms and then scheduled an office visit. How would I bill for this? 99212-99215 (Established Office E/M) or 99422 (Online digital E/M 11-20 minutes?

Answer: Online Digital E/M services (99421, 99422, 99423) are to be used for established patients, only. They are time-based codes and cumulative up to seven days. They are to be reported for asynchronous communication via HIPAA-compliance secure platforms, such as through the electronic health record portal, portal email, etc. They may not be reported if an E/M occurs within seven days before or after, though the time may be incorporated into the subsequent E/M. These codes are not to be used for communication of test results, scheduling of appointments, or other communication that does not include E/M. In your example, you would report the appropriate Office/ Outpatient Established CPT code (99212-99215).


99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

99422 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

99423 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes


Question: Is Cardiopulmonary Resuscitation in the Intensive Care Unit considered to be part of Critical Care services? (99291- 99292)? There appears to be confusion in our billing department on this issue.

Answer: 92959 Cardiopulmonary resuscitation is not bundled into 99291-99292. Consider it as a procedure. To code for this service in addition to Critical Care, the time for the CPR must be separate from the time for Critical Care (99291-99292). A separate procedure note must also be documented. There is no minimum time for this service, and a 25 modifier must be included, as well. 92950 reimburses at 4.00 wRVUs and may be reported two times per calendar day.

Originally published in the September 2023 issue of the American Thoracic Society’s ATS Coding & Billing Quarterly. Republished with permission from the American Thoracic Society.

Pulmonary physicians and particularly interventional bronchoscopists have been receiving denials when CPT^® codes 31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe and 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) are billed during the same procedure.

While the difference between a transbronchial forceps biopsy and transbronchial needle biopsy are obvious to bronchoscopists, there has been confusion with payers. This could have been partly on the basis of a CPT Assistant article from March 2021 describing the use of both codes that stated, “Note that performing two types of lung biopsy (forceps and needle aspiration) on the same lesion would be considered unusual and documentation of medical necessity should clearly describe why both types of biopsy were clinically necessary.” This may have been interpreted by coders and/or payers to mean that the two codes should be billed together rarely or not at all. It is also possible that computer-based coding programs (eg, Optum/Encoder Pro, etc) are responsible for these inappropriate denials. There are, however, no NCCI edits that disallow this nor was this the intent of the CPT codes when they were developed.

The previous statement from the CPT Assistant article was clarified in the following sentences, “For example, if needle aspiration were performed and immediate screening of the sample were insufficient for diagnosis, a forceps biopsy would be appropriate and reported separately. On the other hand, if a physician performed a needle aspiration out of concern that the lesion was vascular and found that it was not and proceeded with a forceps biopsy, then the needle aspiration would be integral to the forceps biopsy and not separately reported.” Importantly, with the increasing use of navigational bronchoscopy and robotic bronchoscopy, these codes will be used together more frequently, appropriately, and correctly, especially on distal lesions.

Remember, these codes are used for procedures in a single lobe. If multiple lobes are sampled then CPT codes 31632 and 31633 would be added to 31628 and 31629, respectively. If one is receiving denials for these procedures, coders and payers should be notified of these errors, and denials should be appealed.

Q&A

Question: My practice is wondering if we can use the newer codes for online digital E/M services? We know they are time-based, but we are confused about when they cannot be used. Can you please help? For example, I had an established COPD patient send a message through the electronic health record’s patient portal reporting new symptoms of headache, cough, and sputum production. They asked me to review the chest x-ray that was done two days prior when they went to urgent care. The patient is asking for an assessment and management plan. We message back and forth over the next day for a total of 13 minutes. Three days later, the patient developed more symptoms and then scheduled an office visit. How would I bill for this? 99212-99215 (Established Office E/M) or 99422 (Online digital E/M 11-20 minutes?

Answer: Online Digital E/M services (99421, 99422, 99423) are to be used for established patients, only. They are time-based codes and cumulative up to seven days. They are to be reported for asynchronous communication via HIPAA-compliance secure platforms, such as through the electronic health record portal, portal email, etc. They may not be reported if an E/M occurs within seven days before or after, though the time may be incorporated into the subsequent E/M. These codes are not to be used for communication of test results, scheduling of appointments, or other communication that does not include E/M. In your example, you would report the appropriate Office/ Outpatient Established CPT code (99212-99215).


99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

99422 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

99423 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes


Question: Is Cardiopulmonary Resuscitation in the Intensive Care Unit considered to be part of Critical Care services? (99291- 99292)? There appears to be confusion in our billing department on this issue.

Answer: 92959 Cardiopulmonary resuscitation is not bundled into 99291-99292. Consider it as a procedure. To code for this service in addition to Critical Care, the time for the CPR must be separate from the time for Critical Care (99291-99292). A separate procedure note must also be documented. There is no minimum time for this service, and a 25 modifier must be included, as well. 92950 reimburses at 4.00 wRVUs and may be reported two times per calendar day.

Originally published in the September 2023 issue of the American Thoracic Society’s ATS Coding & Billing Quarterly. Republished with permission from the American Thoracic Society.

Pulmonary physicians and particularly interventional bronchoscopists have been receiving denials when CPT^® codes 31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe and 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) are billed during the same procedure.

While the difference between a transbronchial forceps biopsy and transbronchial needle biopsy are obvious to bronchoscopists, there has been confusion with payers. This could have been partly on the basis of a CPT Assistant article from March 2021 describing the use of both codes that stated, “Note that performing two types of lung biopsy (forceps and needle aspiration) on the same lesion would be considered unusual and documentation of medical necessity should clearly describe why both types of biopsy were clinically necessary.” This may have been interpreted by coders and/or payers to mean that the two codes should be billed together rarely or not at all. It is also possible that computer-based coding programs (eg, Optum/Encoder Pro, etc) are responsible for these inappropriate denials. There are, however, no NCCI edits that disallow this nor was this the intent of the CPT codes when they were developed.

The previous statement from the CPT Assistant article was clarified in the following sentences, “For example, if needle aspiration were performed and immediate screening of the sample were insufficient for diagnosis, a forceps biopsy would be appropriate and reported separately. On the other hand, if a physician performed a needle aspiration out of concern that the lesion was vascular and found that it was not and proceeded with a forceps biopsy, then the needle aspiration would be integral to the forceps biopsy and not separately reported.” Importantly, with the increasing use of navigational bronchoscopy and robotic bronchoscopy, these codes will be used together more frequently, appropriately, and correctly, especially on distal lesions.

Remember, these codes are used for procedures in a single lobe. If multiple lobes are sampled then CPT codes 31632 and 31633 would be added to 31628 and 31629, respectively. If one is receiving denials for these procedures, coders and payers should be notified of these errors, and denials should be appealed.

Q&A

Question: My practice is wondering if we can use the newer codes for online digital E/M services? We know they are time-based, but we are confused about when they cannot be used. Can you please help? For example, I had an established COPD patient send a message through the electronic health record’s patient portal reporting new symptoms of headache, cough, and sputum production. They asked me to review the chest x-ray that was done two days prior when they went to urgent care. The patient is asking for an assessment and management plan. We message back and forth over the next day for a total of 13 minutes. Three days later, the patient developed more symptoms and then scheduled an office visit. How would I bill for this? 99212-99215 (Established Office E/M) or 99422 (Online digital E/M 11-20 minutes?

Answer: Online Digital E/M services (99421, 99422, 99423) are to be used for established patients, only. They are time-based codes and cumulative up to seven days. They are to be reported for asynchronous communication via HIPAA-compliance secure platforms, such as through the electronic health record portal, portal email, etc. They may not be reported if an E/M occurs within seven days before or after, though the time may be incorporated into the subsequent E/M. These codes are not to be used for communication of test results, scheduling of appointments, or other communication that does not include E/M. In your example, you would report the appropriate Office/ Outpatient Established CPT code (99212-99215).


99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

99422 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

99423 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes


Question: Is Cardiopulmonary Resuscitation in the Intensive Care Unit considered to be part of Critical Care services? (99291- 99292)? There appears to be confusion in our billing department on this issue.

Answer: 92959 Cardiopulmonary resuscitation is not bundled into 99291-99292. Consider it as a procedure. To code for this service in addition to Critical Care, the time for the CPR must be separate from the time for Critical Care (99291-99292). A separate procedure note must also be documented. There is no minimum time for this service, and a 25 modifier must be included, as well. 92950 reimburses at 4.00 wRVUs and may be reported two times per calendar day.

Originally published in the September 2023 issue of the American Thoracic Society’s ATS Coding & Billing Quarterly. Republished with permission from the American Thoracic Society.

Pulmonary, critical care, and sleep physicians often provide services to patients, as well as consultative services to other health-care professionals, without a patient being present. This can be done via telephone or electronic (internet or electronic health record) communications. Many are not aware that Current Procedural Terminology (CPT^®) codes were published to describe and define the work involved in these services. In 2019, there will be additional CPT codes available for health-care workers to use for these non-face-to-face services.

Telephone services are reported using CPT codes 99441-99443 and may be used for evaluation and management (E/M) services provided by telephone for an established patient that do not result in a patient visit within the next 24 hours or are associated with an E/M visit from the last 7 days.

99441 Telephone evaluation and management service by a physician or other qualified health-care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M serv ice provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

99442 11-20 minutes of medical discussion

99443 21-30 minutes of medical discussion

These codes may not be reported by a provider more frequently than every 7 days. The details of the service should be documented in the medical record.

If the E/M service is prompted by an online patient request, then CPT code 99444 can be used.

99444 Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the internet or similar electronic communications network.

This code may be reported only every 7 days and can not be related to a previous E/M evaluation in the last 7 days or to a previous surgical procedure. The service includes all of the communication (eg, related telephone calls, prescription provision, laboratory orders) pertaining to the online patient encounter.

There are also CPT codes for Interprofessional Telephone/Internet/Electronic Health Record Consultations. These codes are used when one health-care provider requests the opinion and/or treatment advice of another provider (consultant) for either a new or established patient without face-to-face contact between the patient and the consultant.

99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.

99447 11-20 minutes of medical consultative discussion and review

99448 21-30 minutes of medical consultative discussion and review

99449 31 minutes or more of medical consultative discussion and review

These codes are not used if the consultant has seen the patient in a face-to-face encounter within the last 14 days or the consultation results in a transfer of care or other face-to-face service with the consultant within the next 14 days. In addition, greater than 50% of the service time reported must be devoted to the medical consultative verbal or internet discussion. The request and reason for telephone/internet/electronic health record consultation by the requesting health-care professional should be documented in the patient’s medical record. After an oral report from the consultant is provided to the treating/requesting physician, a written report should be documented in the medical record. Consultations of less than 5 minutes should not be reported.

As noted, CPT codes 99446-49 require an oral and written report. A new code is added for 2019.

99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.

CPT code 99451 describes a consultative service lasting more than 5 minutes and requires only a written report to the requesting physician. This was added recognizing that oral communications do not always occur between healthcare professionals and may facilitate consultative services in geographic areas with no specialists available.

99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.

CPT code 99452 is reported for 16-30 minutes preparing for the referral and/or communicating with a consultant. If more than 30 minutes is spent by the treating/requesting healthcare provider, then one would use a prolonged services code (99358-59).

As with all coding and billing issues, review the CPT manual for parentheticals that describe coding rules not included in the code description. In addition, not all CPT codes are paid by all providers. Knowledge of payer policies is, therefore, important for appropriate reimbursement.

Pulmonary, critical care, and sleep physicians often provide services to patients, as well as consultative services to other health-care professionals, without a patient being present. This can be done via telephone or electronic (internet or electronic health record) communications. Many are not aware that Current Procedural Terminology (CPT^®) codes were published to describe and define the work involved in these services. In 2019, there will be additional CPT codes available for health-care workers to use for these non-face-to-face services.

Telephone services are reported using CPT codes 99441-99443 and may be used for evaluation and management (E/M) services provided by telephone for an established patient that do not result in a patient visit within the next 24 hours or are associated with an E/M visit from the last 7 days.

99441 Telephone evaluation and management service by a physician or other qualified health-care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M serv ice provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

99442 11-20 minutes of medical discussion

99443 21-30 minutes of medical discussion

These codes may not be reported by a provider more frequently than every 7 days. The details of the service should be documented in the medical record.

If the E/M service is prompted by an online patient request, then CPT code 99444 can be used.

99444 Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the internet or similar electronic communications network.

This code may be reported only every 7 days and can not be related to a previous E/M evaluation in the last 7 days or to a previous surgical procedure. The service includes all of the communication (eg, related telephone calls, prescription provision, laboratory orders) pertaining to the online patient encounter.

There are also CPT codes for Interprofessional Telephone/Internet/Electronic Health Record Consultations. These codes are used when one health-care provider requests the opinion and/or treatment advice of another provider (consultant) for either a new or established patient without face-to-face contact between the patient and the consultant.

99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.

99447 11-20 minutes of medical consultative discussion and review

99448 21-30 minutes of medical consultative discussion and review

99449 31 minutes or more of medical consultative discussion and review

These codes are not used if the consultant has seen the patient in a face-to-face encounter within the last 14 days or the consultation results in a transfer of care or other face-to-face service with the consultant within the next 14 days. In addition, greater than 50% of the service time reported must be devoted to the medical consultative verbal or internet discussion. The request and reason for telephone/internet/electronic health record consultation by the requesting health-care professional should be documented in the patient’s medical record. After an oral report from the consultant is provided to the treating/requesting physician, a written report should be documented in the medical record. Consultations of less than 5 minutes should not be reported.

As noted, CPT codes 99446-49 require an oral and written report. A new code is added for 2019.

99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.

CPT code 99451 describes a consultative service lasting more than 5 minutes and requires only a written report to the requesting physician. This was added recognizing that oral communications do not always occur between healthcare professionals and may facilitate consultative services in geographic areas with no specialists available.

99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.

CPT code 99452 is reported for 16-30 minutes preparing for the referral and/or communicating with a consultant. If more than 30 minutes is spent by the treating/requesting healthcare provider, then one would use a prolonged services code (99358-59).

As with all coding and billing issues, review the CPT manual for parentheticals that describe coding rules not included in the code description. In addition, not all CPT codes are paid by all providers. Knowledge of payer policies is, therefore, important for appropriate reimbursement.

Pulmonary, critical care, and sleep physicians often provide services to patients, as well as consultative services to other health-care professionals, without a patient being present. This can be done via telephone or electronic (internet or electronic health record) communications. Many are not aware that Current Procedural Terminology (CPT^®) codes were published to describe and define the work involved in these services. In 2019, there will be additional CPT codes available for health-care workers to use for these non-face-to-face services.

Telephone services are reported using CPT codes 99441-99443 and may be used for evaluation and management (E/M) services provided by telephone for an established patient that do not result in a patient visit within the next 24 hours or are associated with an E/M visit from the last 7 days.

99441 Telephone evaluation and management service by a physician or other qualified health-care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M serv ice provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

99442 11-20 minutes of medical discussion

99443 21-30 minutes of medical discussion

These codes may not be reported by a provider more frequently than every 7 days. The details of the service should be documented in the medical record.

If the E/M service is prompted by an online patient request, then CPT code 99444 can be used.

99444 Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the internet or similar electronic communications network.

This code may be reported only every 7 days and can not be related to a previous E/M evaluation in the last 7 days or to a previous surgical procedure. The service includes all of the communication (eg, related telephone calls, prescription provision, laboratory orders) pertaining to the online patient encounter.

There are also CPT codes for Interprofessional Telephone/Internet/Electronic Health Record Consultations. These codes are used when one health-care provider requests the opinion and/or treatment advice of another provider (consultant) for either a new or established patient without face-to-face contact between the patient and the consultant.

99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.

99447 11-20 minutes of medical consultative discussion and review

99448 21-30 minutes of medical consultative discussion and review

99449 31 minutes or more of medical consultative discussion and review

These codes are not used if the consultant has seen the patient in a face-to-face encounter within the last 14 days or the consultation results in a transfer of care or other face-to-face service with the consultant within the next 14 days. In addition, greater than 50% of the service time reported must be devoted to the medical consultative verbal or internet discussion. The request and reason for telephone/internet/electronic health record consultation by the requesting health-care professional should be documented in the patient’s medical record. After an oral report from the consultant is provided to the treating/requesting physician, a written report should be documented in the medical record. Consultations of less than 5 minutes should not be reported.

As noted, CPT codes 99446-49 require an oral and written report. A new code is added for 2019.

99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.

CPT code 99451 describes a consultative service lasting more than 5 minutes and requires only a written report to the requesting physician. This was added recognizing that oral communications do not always occur between healthcare professionals and may facilitate consultative services in geographic areas with no specialists available.

99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.

CPT code 99452 is reported for 16-30 minutes preparing for the referral and/or communicating with a consultant. If more than 30 minutes is spent by the treating/requesting healthcare provider, then one would use a prolonged services code (99358-59).

As with all coding and billing issues, review the CPT manual for parentheticals that describe coding rules not included in the code description. In addition, not all CPT codes are paid by all providers. Knowledge of payer policies is, therefore, important for appropriate reimbursement.

There will be a number of changes to Current Procedural Terminology (CPT®) codes of interest to pulmonary/critical care providers in January 2018. A thorough understanding of these changes is important for appropriate coding and reimbursement for the services described by these codes.

There are two changes in the CPT codes for bronchoscopy involving 31645 and 31646. CPT code 31645 describes a therapeutic bronchoscopy, eg, removal of viscous, copious or tenacious secretions from the airway. It had previously included wording that suggested it was used for abscess drainage, and this has been removed. If a therapeutic bronchoscopy procedure is repeated during the same hospital stay, then CPT code 31646 should be utilized. If a therapeutic bronchoscopy procedure is performed in the non-hospital setting and later repeated, then CPT code 31645 would be used for both procedures.

CPT code 94620 Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry) has been deleted and replaced by two new codes. CPT code 94617 Exercise test for bronchospasm, including pre- and postspirometry, electrocardiographic recording(s), and pulse oximetry describes the procedure used to assess for exercise-induced bronchospasm. CPT code 94618 Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed, describes the typical simple pulmonary stress test. After January 1, 2018, if CPT code 94620 is used, the claim will be denied. CPT code 94621 Cardiopulmonary exercise testing, including measurements of minute ventilation, CO₂ production, O₂ uptake, and electrocardiographic recordings has been reworded to better describe the procedure of cardiopulmonary exercise testing. Additionally, there are numerous parentheticals appended that list the CPT codes that may not be used in conjunction with 94617, 94618, and 94621. Please refer to the 2018 CPT manual for further information on these exclusions.

There will be a number of changes to Current Procedural Terminology (CPT®) codes of interest to pulmonary/critical care providers in January 2018. A thorough understanding of these changes is important for appropriate coding and reimbursement for the services described by these codes.

There are two changes in the CPT codes for bronchoscopy involving 31645 and 31646. CPT code 31645 describes a therapeutic bronchoscopy, eg, removal of viscous, copious or tenacious secretions from the airway. It had previously included wording that suggested it was used for abscess drainage, and this has been removed. If a therapeutic bronchoscopy procedure is repeated during the same hospital stay, then CPT code 31646 should be utilized. If a therapeutic bronchoscopy procedure is performed in the non-hospital setting and later repeated, then CPT code 31645 would be used for both procedures.

CPT code 94620 Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry) has been deleted and replaced by two new codes. CPT code 94617 Exercise test for bronchospasm, including pre- and postspirometry, electrocardiographic recording(s), and pulse oximetry describes the procedure used to assess for exercise-induced bronchospasm. CPT code 94618 Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed, describes the typical simple pulmonary stress test. After January 1, 2018, if CPT code 94620 is used, the claim will be denied. CPT code 94621 Cardiopulmonary exercise testing, including measurements of minute ventilation, CO₂ production, O₂ uptake, and electrocardiographic recordings has been reworded to better describe the procedure of cardiopulmonary exercise testing. Additionally, there are numerous parentheticals appended that list the CPT codes that may not be used in conjunction with 94617, 94618, and 94621. Please refer to the 2018 CPT manual for further information on these exclusions.

There will be a number of changes to Current Procedural Terminology (CPT®) codes of interest to pulmonary/critical care providers in January 2018. A thorough understanding of these changes is important for appropriate coding and reimbursement for the services described by these codes.

There are two changes in the CPT codes for bronchoscopy involving 31645 and 31646. CPT code 31645 describes a therapeutic bronchoscopy, eg, removal of viscous, copious or tenacious secretions from the airway. It had previously included wording that suggested it was used for abscess drainage, and this has been removed. If a therapeutic bronchoscopy procedure is repeated during the same hospital stay, then CPT code 31646 should be utilized. If a therapeutic bronchoscopy procedure is performed in the non-hospital setting and later repeated, then CPT code 31645 would be used for both procedures.

CPT code 94620 Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry) has been deleted and replaced by two new codes. CPT code 94617 Exercise test for bronchospasm, including pre- and postspirometry, electrocardiographic recording(s), and pulse oximetry describes the procedure used to assess for exercise-induced bronchospasm. CPT code 94618 Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed, describes the typical simple pulmonary stress test. After January 1, 2018, if CPT code 94620 is used, the claim will be denied. CPT code 94621 Cardiopulmonary exercise testing, including measurements of minute ventilation, CO₂ production, O₂ uptake, and electrocardiographic recordings has been reworded to better describe the procedure of cardiopulmonary exercise testing. Additionally, there are numerous parentheticals appended that list the CPT codes that may not be used in conjunction with 94617, 94618, and 94621. Please refer to the 2018 CPT manual for further information on these exclusions.