CPT® and ICD-10 Coding for Endobronchial Valves

The FDA recently approved endobronchial valves for the bronchoscopic treatment of adult patients with hyperinflation associated with severe emphysema in regions of the lung that have little to no collateral ventilation. There are CPT® and ICD 10 codes that are appropriate to report these new services. CPT® codes typically are not product or device specific and the codes below apply to current and future FDA approved endobronchial valves with similar clinical indications and intent for the treatment of emphysema.

To be a candidate for the currently approved service, patients must have little to no collateral ventilation between the target and adjacent lobes. In some patients, this can be determined by a quantitative CT analysis service to assess emphysematous destruction and fissure completeness. If there is radiographic evidence of a complete fissure and anatomic isolation of the treatment target, a bronchoscopy assessment will be made on the patient. A bronchial blocking balloon and flow detection system is used to confirm that the patient has little to no collateral ventilation.

If the bronchial blocking technique shows evidence of collateral ventilation, the patient would be discharged without valve placement. In that scenario the appropriate CPT® code would be 31634:

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If the patient is determined not to have collateral ventilation, the valve procedure would proceed, followed by a minimum three-day inpatient stay to monitor for possible side effects.

The appropriate CPT codes for placing, and removing FDA approved valves are:

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The table below identifies potential ICD-10-CM diagnosis codes for emphysema. Applicability and usage of these codes may vary per case. Hospitals and physicians also should check and verify current policies and requirements with the payer for any patient who will be treated with endobronchial valves.

INSERT GRAPHIC HERE
 

The CHEST/ATS Clinical Practice Committee provided information for this article.


 

The FDA recently approved endobronchial valves for the bronchoscopic treatment of adult patients with hyperinflation associated with severe emphysema in regions of the lung that have little to no collateral ventilation. There are CPT® and ICD 10 codes that are appropriate to report these new services. CPT® codes typically are not product or device specific and the codes below apply to current and future FDA approved endobronchial valves with similar clinical indications and intent for the treatment of emphysema.

To be a candidate for the currently approved service, patients must have little to no collateral ventilation between the target and adjacent lobes. In some patients, this can be determined by a quantitative CT analysis service to assess emphysematous destruction and fissure completeness. If there is radiographic evidence of a complete fissure and anatomic isolation of the treatment target, a bronchoscopy assessment will be made on the patient. A bronchial blocking balloon and flow detection system is used to confirm that the patient has little to no collateral ventilation.

If the bronchial blocking technique shows evidence of collateral ventilation, the patient would be discharged without valve placement. In that scenario the appropriate CPT® code would be 31634:

INSERT GRAPHIC HERE

If the patient is determined not to have collateral ventilation, the valve procedure would proceed, followed by a minimum three-day inpatient stay to monitor for possible side effects.

The appropriate CPT codes for placing, and removing FDA approved valves are:

INSERT GRAPHIC HERE
 

The table below identifies potential ICD-10-CM diagnosis codes for emphysema. Applicability and usage of these codes may vary per case. Hospitals and physicians also should check and verify current policies and requirements with the payer for any patient who will be treated with endobronchial valves.

INSERT GRAPHIC HERE
 

The CHEST/ATS Clinical Practice Committee provided information for this article.


 

The FDA recently approved endobronchial valves for the bronchoscopic treatment of adult patients with hyperinflation associated with severe emphysema in regions of the lung that have little to no collateral ventilation. There are CPT® and ICD 10 codes that are appropriate to report these new services. CPT® codes typically are not product or device specific and the codes below apply to current and future FDA approved endobronchial valves with similar clinical indications and intent for the treatment of emphysema.

To be a candidate for the currently approved service, patients must have little to no collateral ventilation between the target and adjacent lobes. In some patients, this can be determined by a quantitative CT analysis service to assess emphysematous destruction and fissure completeness. If there is radiographic evidence of a complete fissure and anatomic isolation of the treatment target, a bronchoscopy assessment will be made on the patient. A bronchial blocking balloon and flow detection system is used to confirm that the patient has little to no collateral ventilation.

If the bronchial blocking technique shows evidence of collateral ventilation, the patient would be discharged without valve placement. In that scenario the appropriate CPT® code would be 31634:

INSERT GRAPHIC HERE

If the patient is determined not to have collateral ventilation, the valve procedure would proceed, followed by a minimum three-day inpatient stay to monitor for possible side effects.

The appropriate CPT codes for placing, and removing FDA approved valves are:

INSERT GRAPHIC HERE
 

The table below identifies potential ICD-10-CM diagnosis codes for emphysema. Applicability and usage of these codes may vary per case. Hospitals and physicians also should check and verify current policies and requirements with the payer for any patient who will be treated with endobronchial valves.

INSERT GRAPHIC HERE
 

The CHEST/ATS Clinical Practice Committee provided information for this article.