Transcript Respiratory System

Respiratory System
By Alex Munoz, CPC, NCICS
Respiratory System
 Anatomic


site arrangement
Nose
Larynx
 Further subdivided by procedure
 Incision
 Excision
 Introduction
 Removal of foreign body
 Destruction
 Endoscopy
 Other procedures
Endoscopy
 Endoscopy in all subheadings
except Nose
 Each preceded by “Notes”
Endoscopy Rule One:
 Code full Extent
 Example: Procedure begins at mouth and ends at bronchial
tube
 Bronchial tube = full extent
Endoscopy Rule Two:
 Code correct Approach…
 Example, for removal:
 Interior lung lesion via endoscopy inserted through mouth
 Exterior lung lesion via endoscopy inserted through skin
 Incorrect approach = incorrect code = incorrect
Reimbursement..
Endoscopy Rule Three:
 Surgical always includes diagnostic
 Example:
Diagnostic bronchial endoscopy begins
 Identifies foreign body
 Removed (surgical endoscopy)

Multiple Procedures
 Frequent in respiratory coding
 Watch for bundled services
 Medicare—reference the CCI edits
 Sequence primary procedure first, no modifier
 Sequence secondary procedures next, with -51
Bilateral Procedure
 Bilateral procedures often performed
 Format for reporting chosen by payer
 Example: Nasal lavage
31000 x 2
 31000 and 31000-50
 31000-50
 31000-RT and 31000-LT

 Medicare requires one line item with modifier -50
Laryngoscopic Procedures
 Uses terms indirect and direct
 Indirect: Tongue depressor with mirror used to view
larynx
 Direct: Endoscopy passed into larynx, physician
directly views vocal cords
Nose (30000-30999)
 Used extensively by otorhinolaryngologists
(ear, nose, and throat specialists ENT)
 But also used by a wide variety of physicians
(Cont’d…)
Nose (30000-30999)
(…Cont’d)
 When approach to nose:
 External approach, use Integumentary System codes
 Internal approaches, use Respiratory System codes
Nose, Incision
(30000, 30020)
 Bundled into Incision codes, drain or gauze insertion
and removal
 Supplies reported separately
Nose, Excision
(30100-30160)
• Contains intranasal biopsy codes
• Polyp excision, by Complexity
• “Simple” involves polyps that are easy to remove
• “Extensive” involves sessile polyps (thick base)
–
More time consuming and requires a
level (30115)
greater skill
• Excision includes any method of destruction, even laser
• Use -50 (bilateral) for both sides
• Reduction of turbinates, 30140
Nasal Turbinates
• Nasal turbinates
• Excision of turbinates are considered unilateral
• If performed bilaterally, use modifier -50
Nose, Introduction
(30200-30220)
• Common procedures
• Example: Injections
to shrink nasal
turbinate tissue
• Displacement therapy
(Saline flush) performed
through nose to remove
mucus
• Insertion of nasal button
Nose, Removal of
Foreign Body (30300-30320)
 Divided by whether removal at office or hospital
(requires general anesthesia)
Nose, Repair
(30400-30630)
• Many plastic surgery procedures, such as:
–
–
–
–
Rhinoplasty (reshaping nose, internal and/or
external)
Stated as “revision” or “primary”
Rhinoplasty for nasal deformity secondary to
congenital cleft lip/palate
Septoplasty (rearrangement of nasal septum)
• Included in a rhinoplasty
Nasal Reconstruction
 Codes for obtaining grafts for nasal reconstruction
surgery are in Musculoskeletal subsection
 Codes for other procedures on the nose are in
Integumentary subsection

External approach
Nose, Destruction
(30801, 30802)
 Use of ablation (removing by cutting)
 Used for removal of excess nasal mucosa or to reduce
turbinate inflammation
Nose, Destruction
(30801, 30802)
 Based on intramural or superficial extent of
destruction
 Intramural: deeper mucosa
 Superficial: outerlayer of mucosa
Nasal Hemorrhage
(30901-30906)
 Code based on:
 Site of hemorrhage (anterior or posterior)
 Control was simple or complex
 If a posterior hemorrhage, was it the initial or a
subsequent procedure
Nose, Other Procedures
(30901-30999)
 Control of nasal hemorrhage
 Packing
 Ligation
 Cauterization
 Anterior packing placed through nose
 Posterior packing placed at very back of throat
 Code 92511 (nasopharyngoscopy with endoscope) is
bundled into any respiratory procedure performed
at the same session
Nose, Other Procedures
 Anterior packing
 When surgery is performed solely to improve the
patient’s appearance (no signs/symptoms), it is
cosmetic
 Non-covered under the Medicare program
(DX V50.1)
Nose, Other Procedures
 A balloon may
be inserted to further control bleeding
 Hemorrhage may require the insertion of
stents, tampons, nasal catheters, or posterior
packing
 Simple packing with gauze or anterior packing
suggests a simple procedure
Accessory Sinuses, Incision,
Excision, Endoscopy (31000-31299)
 Codes for lavage (washing) of sinuses
 Cannula (hollow tube) placed into sinus, saline solution
flushed through
 Use -50 (bilateral) for both sides
 Sinusectomy: All sinus contents including mucous
membranes are removed
 Antrostomy: Making an opening into the sinus
 An “antrotomy” means cutting into the sinus
Larynx, Excision
(31300-31420)
 Laryngotomy: open surgical procedure to
expose larynx

For removal procedure (e.g., tumor)
 Sometimes confused with Trachea/Bronchi
codes for tracheostomy

Used to establish airflow
Laryngoscopy
 Visual examination of the
larynx
 Flexible lighted tube passed
through mouth or nose into
larynx
Larynx, Introduction
(31500, 31502)
 Endotracheal intubation is establishment of airway
 Numerous CCI edits
 Intubation: Endotracheal intubation involves a
tube placed through the nose or mouth, through the
pharynx and larynx, and into the trachea to establish
an airway
Larynx, Repair
(31580-31590)
 Several plastic procedures and fracture repairs
 Laryngoplasty procedures based on purpose
 Endoscopy (31615-31656)
 Bronchoscope inserted into nose or mouth
 Rigid endoscopy performed under general anesthesia
 Flexible endoscopy performed under local or
conscious sedation
Trachea and Bronchi, Introduction (31715-31730)
 Injection
 Catheterization
 Aspiration
 Transtracheal introduction
 Some include inhaled gas as contrast material
Trachea and Bronchi, Excision, Repair (3175031830)
 Plastic repairs of trachea and bronchi
 Excision of stenosis/tumors
 Suturing tracheal wounds
 Scar revision
Lungs and Pleura, Incision/Excision
 Biopsy codes in Incision and Excision categories
 Excisional biopsy with percutaneous needle
 Incisional biopsy with chest open
 Includes pneumocentesis and lung removal
 Segmentectomy : 1 segment
 Lobectomy : 1 lobe
 Bilobectomy : 2 lobes
 Total pneumonectomy: 1 lung
Lungs and Pleura, Incision
(32035-32225)
 Thoracotomy: Surgical opening of chest to expose to
view

Used for
Biopsy
 Cyst
 Foreign body removal
 Cardiac massage

Lungs and Pleura, Excision
(32310-32405)
 Biopsy codes in Excision and Incision categories
 Excisional biopsy performed with percutaneous needle
 Incisional biopsy performed with chest open
Lungs and Pleura, Removal
(32421, 32422)
 Thoracentesis: needle or catheter inserted into pleural
space for Aspiration (withdrawal) of fluid or air for
analysis, to drain pleural effusions, or to re-expand a
collapsed lung
Lungs and Pleura, Removal
(32421, 32422)
 Chest tube may be inserted to drain fluid and is reported in
addition to aspiration
Introduction
(32550, 32551)
 Includes:
 Insertion of tunneled indwelling pleural catheter
 Tube thoracostomy

Includes moderate sedation
 Removal (32552)
 Destruction (32560-32562)
 Chemical pleurodesis or effusion

For recurrent persistent pneumothorax or multiloculated effusion
Thoracoscopy
(32601-32674)
 Diagnostic and surgical lung procedures
 Surgical thoracoscopy always includes diagnostic
thoracoscopy
References:
BUCK, C. (2010). STEP BY STEP. ELSEVIER.