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CHEST Physician Editorial Board Member
Confusion in EBUS Coding
There has been some confusion about appropriate coding using the new endobronchial ultrasound codes with some of the other bronchoscopy codes. Notably, when CPT code 31629 bronchoscopy with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) is appropriate to use with code 31652 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures and code 31653 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures. Both 31652 and 31653 include needle sampling as a part of the work and therefore, if the bronchoscopy involves only one these procedures, it would be inappropriate to include 31629.
However, mediastinal sampling is often done in conjunction with evaluation of a more peripheral lesion. If a bronchoscopy is performed with needle biopsy(ies) of a peripheral lesion and subsequently an EBUS scope is used to sample mediastinal or hilar lymph node stations, one could utilize 31629 and either 31652 or 31653. As an illustrative example, a 75-year-old man is found to have a 2-cm peripheral nodule in the anterior segment of the right-upper lobe with enlarged right hilar and subcarinal lymph nodes on CT scan. Bronchoscopy is performed, and, initially, the patient has a survey bronchoscopy using a non-EBUS scope, and no lesion is visible. A radial ultrasound probe is used to help identify the peripheral lesion, and multiple needle biopsies are performed as are brushings and washings. Subsequently, an EBUS scope is introduced, and right hilar, right paratracheal, and subcarinal needle biopsies were performed. The appropriate codes to utilize to describe the work done in this procedure include 31623, 31629, 31653, and 31654. Had no peripheral needle biopsies been performed, then code 31629 would NOT be used. Hopefully, this clarifies the issue further.
CMS Ceases Use of HCPCS G Codes for Smoking Cessation
Effective on or after October 1, the Centers for Medicare & Medicaid Services (CMS) will no longer allow use of Healthcare Common Procedural Coding System (HCPCS) codes G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes). Instead, CMS will utilize the new codes developed for the Current Procedural Terminology (CPT) code set.
CMS has advised its Medicare contractors to replace code G0436 with CPT code 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and code G0437 with CPT code 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes). According to the Medicare National Coverage Determination Manual, tobacco cessation counseling is covered both for symptomatic and asymptomatic smokers. CMS will allow health-care providers two attempts per 12 months to encourage Medicare patients to cease tobacco use but does not define an attempt. Rather, either of the codes may be used up to four times per attempt; so 99406 and 99407 or a combination of these codes may be used up to 8 times in a 12-month period. These codes may be used either as a stand-alone or with an evaluation and management (E&M) service with appropriate documentation. Remember, however, if one uses these codes during an E&M visit, a 25 modifier will need to be appended to the E&M code.
CHEST Physician Editorial Board Member
Confusion in EBUS Coding
There has been some confusion about appropriate coding using the new endobronchial ultrasound codes with some of the other bronchoscopy codes. Notably, when CPT code 31629 bronchoscopy with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) is appropriate to use with code 31652 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures and code 31653 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures. Both 31652 and 31653 include needle sampling as a part of the work and therefore, if the bronchoscopy involves only one these procedures, it would be inappropriate to include 31629.
However, mediastinal sampling is often done in conjunction with evaluation of a more peripheral lesion. If a bronchoscopy is performed with needle biopsy(ies) of a peripheral lesion and subsequently an EBUS scope is used to sample mediastinal or hilar lymph node stations, one could utilize 31629 and either 31652 or 31653. As an illustrative example, a 75-year-old man is found to have a 2-cm peripheral nodule in the anterior segment of the right-upper lobe with enlarged right hilar and subcarinal lymph nodes on CT scan. Bronchoscopy is performed, and, initially, the patient has a survey bronchoscopy using a non-EBUS scope, and no lesion is visible. A radial ultrasound probe is used to help identify the peripheral lesion, and multiple needle biopsies are performed as are brushings and washings. Subsequently, an EBUS scope is introduced, and right hilar, right paratracheal, and subcarinal needle biopsies were performed. The appropriate codes to utilize to describe the work done in this procedure include 31623, 31629, 31653, and 31654. Had no peripheral needle biopsies been performed, then code 31629 would NOT be used. Hopefully, this clarifies the issue further.
CMS Ceases Use of HCPCS G Codes for Smoking Cessation
Effective on or after October 1, the Centers for Medicare & Medicaid Services (CMS) will no longer allow use of Healthcare Common Procedural Coding System (HCPCS) codes G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes). Instead, CMS will utilize the new codes developed for the Current Procedural Terminology (CPT) code set.
CMS has advised its Medicare contractors to replace code G0436 with CPT code 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and code G0437 with CPT code 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes). According to the Medicare National Coverage Determination Manual, tobacco cessation counseling is covered both for symptomatic and asymptomatic smokers. CMS will allow health-care providers two attempts per 12 months to encourage Medicare patients to cease tobacco use but does not define an attempt. Rather, either of the codes may be used up to four times per attempt; so 99406 and 99407 or a combination of these codes may be used up to 8 times in a 12-month period. These codes may be used either as a stand-alone or with an evaluation and management (E&M) service with appropriate documentation. Remember, however, if one uses these codes during an E&M visit, a 25 modifier will need to be appended to the E&M code.
CHEST Physician Editorial Board Member
Confusion in EBUS Coding
There has been some confusion about appropriate coding using the new endobronchial ultrasound codes with some of the other bronchoscopy codes. Notably, when CPT code 31629 bronchoscopy with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) is appropriate to use with code 31652 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures and code 31653 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures. Both 31652 and 31653 include needle sampling as a part of the work and therefore, if the bronchoscopy involves only one these procedures, it would be inappropriate to include 31629.
However, mediastinal sampling is often done in conjunction with evaluation of a more peripheral lesion. If a bronchoscopy is performed with needle biopsy(ies) of a peripheral lesion and subsequently an EBUS scope is used to sample mediastinal or hilar lymph node stations, one could utilize 31629 and either 31652 or 31653. As an illustrative example, a 75-year-old man is found to have a 2-cm peripheral nodule in the anterior segment of the right-upper lobe with enlarged right hilar and subcarinal lymph nodes on CT scan. Bronchoscopy is performed, and, initially, the patient has a survey bronchoscopy using a non-EBUS scope, and no lesion is visible. A radial ultrasound probe is used to help identify the peripheral lesion, and multiple needle biopsies are performed as are brushings and washings. Subsequently, an EBUS scope is introduced, and right hilar, right paratracheal, and subcarinal needle biopsies were performed. The appropriate codes to utilize to describe the work done in this procedure include 31623, 31629, 31653, and 31654. Had no peripheral needle biopsies been performed, then code 31629 would NOT be used. Hopefully, this clarifies the issue further.
CMS Ceases Use of HCPCS G Codes for Smoking Cessation
Effective on or after October 1, the Centers for Medicare & Medicaid Services (CMS) will no longer allow use of Healthcare Common Procedural Coding System (HCPCS) codes G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes). Instead, CMS will utilize the new codes developed for the Current Procedural Terminology (CPT) code set.
CMS has advised its Medicare contractors to replace code G0436 with CPT code 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and code G0437 with CPT code 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes). According to the Medicare National Coverage Determination Manual, tobacco cessation counseling is covered both for symptomatic and asymptomatic smokers. CMS will allow health-care providers two attempts per 12 months to encourage Medicare patients to cease tobacco use but does not define an attempt. Rather, either of the codes may be used up to four times per attempt; so 99406 and 99407 or a combination of these codes may be used up to 8 times in a 12-month period. These codes may be used either as a stand-alone or with an evaluation and management (E&M) service with appropriate documentation. Remember, however, if one uses these codes during an E&M visit, a 25 modifier will need to be appended to the E&M code.