Chapter Nine NS13pptC09_P2

Chapter 9: Respiratory System 30000-32999 Anatomical division of subheadings Examples: Nose Accessory sinuses Larynx The codes in this subsection are divided by anatomy. Procedures are listed under each anatomic subheading. NS13pptC09_P2

Subheadings Usually include: Incision Excision Introduction Endoscopy Repair Destruction Other Procedures NS13pptC09_P2

Tracheostomy Types Approaches Patient age Planned (31600, 31601) or emergency (31603, 31605) Approaches Transtracheal or cricothyroid membrane Patient age Considered in planned procedure Is a tracheostomy an emergency procedure? (may be performed as an emergency procedure or it may be planned) A planned tracheostomy is performed to provide the patient with ventilation support. Determined by patient age. 31600 if over two years or 31601, younger than two years. What is the anatomical location of the incision for the transtracheal tracheostomy go? (across the trachea; the incision is vertical over the cricothyroid) NS13pptC09_P2

Endoscopic Procedures Use of a scope Less invasive Less recovery time Report the farthest point to which the scope is passed Endoscopic procedures involve the use of a scope and are less invasive than an incisional (surgical) procedure. When reporting endoscopic procedures, report to the fullest extent of the procedure, meaning the farthest point to which the scope is passed. When multiple endoscopic procedures are performed during the same operative session, list the most resource-intensive procedure first and then any subsequent procedures with modifier -51. There are many bundled procedures in the respiratory codes. Do not unbundle services that can be reported with one code. NS13pptC09_P2

Thoracentesis Withdrawing of fluid from pleural space May be necessary for conditions such as CHF, pneumonia, etc. Drainage tube may be left in place Included in service code Not reported separately Occurs with conditions such as pleural effusion, CHF, pneumonia, etc. The drain tube may be left in place and does not need to be reported separately. NS13pptC09_P2

Respiratory (in the Medicine Section) 94010-94799: Pulmonary 95070, 95071: Inhalation bronchial challenge testing Therapeutic and diagnostic services Examples: 94642: Aerosol inhalation for treatment of pneumonia 94010: Spirometry What categories of codes are used in the pulmonary subsection of the CPT manual? (diagnostic studies and therapeutic treatments) NS13pptC09_P2

Spirometry (94010-94070) Measures breathing capacity Spirogram Also used as therapy Usually performed by technician under supervision of physician Patient-initiated (94014-94016) Teletransmission from patient to laboratory (Cont'd…) What does spirometry measure? (breathing capacity, but may also be used as therapy) Who usually performs spirometry? (a technician under the supervision of a physician) Spirometry may be patient-initiated, with the data submitted via telephone transmission from the patient's location to the pulmonary laboratory. NS13pptC09_P2

Spirometry Forced vital capacity (FVC) Forced expiratory volume (FEV1) (…Cont'd) Forced vital capacity (FVC) Maximum volume of air exhaled Forced expiratory volume (FEV1) Maximum volume of air exhaled at 1 second after inhalation FEV1 /FVC% Ratio of FEV divided by FVC Inhaled and exhaled air (Cont'd…) What do assessments in a spirometry report include? (forced vital capacity, expiratory volume, expiration ratio and flow rate and total lung capacity) Forced vital capacity (the maximum volume a patient can exhale after maximum inspiration) Forced expiratory volume (volume that can be expired at the first second after a maximum inhalation) Forced expiration ratio (forced expiratory volume divided by forced vital capacity) NS13pptC09_P2

Spirometry Peak expiratory flow rate (PEFR) Total lung capacity (…Cont'd) Peak expiratory flow rate (PEFR) Speed of exhalation Total lung capacity Volume of air lungs will hold What does the peak expiratory flow rate measure? (the fastest speed at which the patient can expel air from the lungs at a maximum effort) What is total lung capacity? (lung volume following a maximum inspiration) NS13pptC09_P2

Complete Spirometry (94070) Flow volume loop (as in 94010) Measures inhalation and exhalation Exposure to irritants Pre-bronchodilator and post-bronchodilator values Measures function before and after bronchodilator use Maximal ventilation value (MVV) (as in 94200) Amount of air exhaled after 60-second inhalation Complete spirometry bundles the flow volume loop, the prebronchodilator and postbronchodilator values, and the maximal ventilation value. NS13pptC09_P2

Bronchospasm Constriction of airway Example: Asthma Provoked bronchospasms by administration of agent Histamine Methacholine Measurements of changes in breathing capacities A bronchospasm is the constriction of the airways of the lung by a contraction of the muscles of the bronchial area. These contractions obstruct airflow and indicate a lung disorder such as asthma or allergy. What is administered before and after a bronchodilator to measure the changes in breathing capacity? (spirometry) NS13pptC09_P2

Nitrogen Washout or FRC (94727)—Lung Volume Determination Functional residual capacity (FRC) Lung volume at end of normal exhalation Is a lung volume determination Mathematical calculation Not reported with 94726 (plethysmography) Functional residual capacity is also known as what? (nitrogen washout) What does the test measure? (lung volume at the end of normal exhalation) Inadequate exhalation is a sign of a pulmonary disorder, such as emphysema. NS13pptC09_P2

Thoracic Gas Volume (TGV) (94726)—Spirometry Includes: Single breath volume Airway collapse or air trapping Assesses lung function and amount of air remaining in lungs after exhalation Not reported with 94727 (washout) or 94728 (airway resistance) Thoracic gas volume is a pulmonary function test. What else is it known as? (plethysmography lung volume or lung volumes) What does the test assess? (lung function and includes the residual volume in the patient's lungs after exhaling) What does the assessment include? (volume of a single breath, air trapping or air caught in a collapsed bronchial branch, and airway collapse or closure of a branch or branches of the bronchial tree) NS13pptC09_P2

DLCO—Diffusion Capacity Diffusion capacity of carbon monoxide Also known as transfer factor Spirometry measuring ability of lungs to perform gas exchange Inhalation: Air with helium and carbon monoxide Exhalation: Air measured to indicate gas diffusion Add-on code Diffusion lung capacity of carbon monoxide, or DLCO (94729), is also known as what? (transfer factor) What does the test measure? (the ability of the lungs to perform gas exchange) The patient inhales a mixture of helium and carbon monoxide and holds it in the lungs for a few seconds. What happens during inhalation? The lungs diffuse the mixture into the pulmonary blood. The patient then exhales and a sample is taken. This test is useful in diagnosing interstitial lung disease. NS13pptC09_P2

Airway Resistance—Lung Volume Determination (94726/94728) Measures resistance air encounters in respiration Measured in single breath exhalation 94726: Using plethysmography 94728: Using impulse oscillometry How is a determination of resistance to airflow measured? (by the air exhaled from the lungs in a single breath) NS13pptC09_P2

Sleep Studies (95800-95811) Used in the diagnosis of sleep disorders Period of 6 or more hours Conducted in laboratory Parameters in medical record and direct code choice Sleep study parameters determine code assignment. These may include electrocardiography, airflow, ventilation and respiration effort, gas exchanges, extremity muscle activity, snoring, and other parameters listed in the CPT. NS13pptC09_P2

CPT Index Pulmonary: Diagnostic Therapeutic The pulmonology codes are divided into two subsections in the CPT index: diagnostic and therapeutic. NS13pptC09_P2

Conclusion NS13pptC09_P2