137 terms

Respiratory System, Chapter 20

Step-by-step coding
Coding of respiratory system
arranged in Respiratory subsection by anatomic site and then by procedure
Endoscopy coding of respiratory system
listed throughout respiratory subsection according to anatomical site
Fracture repairs of nose, sternum, etc.
listed in musculoskeletal subsection of CPT code book
Throat and mouth procedure coding
not located in Respiratory subsection but in Digestive system subsection
Coding respiratory
Read all notes and code information to ensure that you do not code components of the procedure separately if there is one code that includes all of the components
Rhinoplasty can be performed either _____, through external skin incisions, or closed, through ____ incisions.
open or intranasal
Endoscopic procedures
a scope is placed through an existing body orifice (opening), or a small incision is made into a cavity for scope placement
How to code sinus endoscopies
report unilateral (on one side) procedures except in the case of a diagnostic nasal endoscopy which is unilateral or bilateral
Coding multiple sinus procedures
CPT manual has combined into single code some multiple sinus procedures commonly performed at same operative session
Code to the full extent of the procedure
When coding endoscopic procedures that start at one site and follow through to another site.
choose code that most appropriately reflects the furthest extent of the procedure
Code the correct approach for the procedure. The same surgical procedure may be performed using different approaches.
surgical incision into the chest wall
visual examination of the lungs, pleura, and pleural space with a scope inserted through a small incision between the ribs
Coding multiple endoscopic procedures performed through the same scope during operative session
Each procedure should be reported with modifier-51 (multiple procedures) placed on subsequent procedure(s).
bronchoscopy with biopsy with removal of a foreign body
code bronchoscopy with biopsy
code removal of a foreign body with modifier -51
Intranasal procedures may require that surgical instruments be placed into the nose but do not require an endoscope
Coding when an endoscope is used in a nasal/sinus procedure
assign a nasal/sinus endoscopy code
Diagnostic endoscopy coding
always bundled into a surgical endoscopy
If a physician began a diagnostic endoscopic nasal procedure, continuing on to complete a surgical procedure,
code only the surgical procedure
If diagnostic sinus endoscopy is performed on right maxillary sinus and a surgical endoscopic maxillectomy on the left
both procedures are coded with appropriate - LT and -RT modifiers because two different procedures were performed
laryngoscopic procedures
direct or indirect
Indirect laryngoscopy
physician used tongue depressor to hold the tongue down and view the epiglottis with a mirror, patient says "ah" and vocal cords are viewed
Direct laryngoscopy
endoscope is passed into larynx and physician looks directly at larynx
Where endoscopy codes are located in CPT manual index
under endoscopy and then under the anatomic subterm of the site, or by anatomic endoscopy title
ear, nose and throat specialist
1. endoscopic maxillary antrostomy
cpt code 31256
2. direct laryngoscopy for removal of fish bone
3. after the airway is sufficiently anestheized, a flexible bronchoscope is inserted through the mouth and advanced to the bronchus, where a transbronchial biopsy of one lobe is obtained
CPT code: 31628
4. Diagnostic thoroscopy of the mediastinal space is accomplished with the use of a flexible endoscope is inserted through a small inicision on the chest (no biopsy was performed)
CPT code: 32601
5. Segmental resection o the right single lung lobe using a flexible endoscope (surgical thoracoscopy)
CPT code: 32663
codes for incision of nasal abscess
divided on whether abscess is on nasal mucosa or septal mucosa
nasal incision external approach
coded from Integumentary subsection
internal nasal approach
coded from Respiratory subsection
use Medicine section code for supplies, 99070 or HCPCS code as directed by 3rd party payer
When two procedures are completed during the same surgical session, the most complex procedure is sequenced first.
Coding biopsy of nose
intranasally - coded from respiratory subsection
externally - coded from integumentary subsecdtion
Nasal polyp excision coding
coding depends on extent of excision: extensive polyp excision usually performed in hospital setting
When polyps are removed from both the left and right sides of the nose
modifier -50(bilateral) assigned
coding excision or destruction of lesions inside nose
codes based on approach -internal (respiratory) or external (integumentary)
exceptions to the rules
if laser was used in destruction of lesion, separate set of codes just for laser destruction; BUT in nose category laser included as one of destruction methods.
bones on inside of nose - also called nasal conchae, dived into 3 sections, inferior, middle and superior
coding turbinate bone removal due to chronic congestion or neoplastic growth
document medical necessity for these noncosmetic procedures
Introduction coding (30200-30220)
include injection, displacement therapy and i nsertion
injections in the turbinates
(steroid) therapeutic injections to shrink nasal tissue to improve breathing
displacement therapy (30210)
saline solution flushes the sinuses to remove mucus or pus
insertion of nasal button
technique to repair perforated septum without surgical graftin. A nasal button (silicone or rubber) is sutured in place
coding removal of a foreign body
coding depends on removal in office or extensive removal requiring general anesthesia and more invasive surgical procedure
Nasal repair (30400-30630)
procedures: rhinoplasty, septoplasty, and septodermatoplasty
procedure to reshape nose internally, externally, or both, coding based on extent (minor, intermediate, major) whether septum was also repaired and initial or secondary procedure
rearrangement of nasal septum, commonly due to deviated septum. Septoplasty code 30520 is reported when the nasal septum is resected
Do not use a septoplasty code if operative report indicates that only a resection of the inferior turbinate(s) was performed.
The resection of the inferior turbinate(s) is reported with 30140 and is not a procedure performed on the septum
can be accomplished by use of ablation
removal, usually by cutting
ablation or cauterization is performed to remove excess nasal mucosa or to reduce inflammation
Destruction codes dived according to extent of procedure
superficxial or intra mural
intramural ablation
ablation of deeper mucosa
superficial ablation
only outer layer of mucosa
other procedures (30901-30920)
control of nasal hemorrhage is found under these codes
control of nasal hemorrhage
coding may be use of anterior or posterior pressure to control hemorrhage. codes divided according to type (anterior/posterior) and extent of control required (level of complexity)
anterior nasal packing
application of pressure using packing to the anterior aspect of the nasal cavity
posterior nasal packing
application of pressure using packing to posterior aspect of nasal cavity
binding or tying off blood vessels, for nasal hemorrhage could be ethmoid or maxillary artery
therapeutic fracture of nasal turbinate
fracturing of turbinate bone and repostioning of it under local anesthetic often to relive obstructed airflow caused by enlarged inferior turbinates or a previous fracture that has healed out of alignment and resulted in deviation of nose.
1. Biopsy of an intranasal lesion
CPT code 30100
2. Primary rhinoplasty including major septal repair due to deviated nasal septum, acquired
CPT code
3. Anterior control of nasal hemorrhage by means of limited chemical cauterizeation and simple packing.
CPT code
4. Septoplasty with contouring and grafting
CPT code:
5. Removal of crayon from nose of 5-year-old boy, conducted as an office procedure
CPT code: 30300 (nose, removal, foreign body)
accesssory sinuses subsection coding
washing nasal sinuses with saline solution introduced through a canula (hollow tube) to remove infection which can be performed on btoh maxillary and sphenoid sinuses
use modifier-50(bilateral) when lavage is performed on both the left and right maxillary sinuses.
procedure in which passage is enlarged or a new passage created from nasal cavity into a sinus (usually due to chronic sinus infection to improve sinus drainage) codes divided according to extent of procedure
1. lavage of maxillary sinus, bilateral
CPT Code
2. Simple left frontal sinusotomy using an external approach
CPT code
3. Unilateral sinusotomy of frontal, ethmoid, and sphenoid
CPT code
4. Right radical maxillary sinusotomy
CPT code
5. Pterygomaxillary fossa surgery, transfacial approach, due to chronic antritis of maxillary sinus
CPT code
incision that is made over the larynx (thyrotomy) to expose the larynx to view
Diagnostic laryngotomy
air-filled space
removal of vocal cords
incision of the larynx through the thyroid cartilage for the purpose of exposing the larynx
performed usually to establish airflow
radical neck dissection
laryngectomy, removal of larynx, lymph glands and/or other surrounding tissue
establishment of an airway (introduction) provided on an emergency basis or occurence of an inadequate airway
laryngoplasty for a laryngeal web
usually performed in two stages for repair of conginital webbing between the vocal cords, Stage 1 webbing removed and spacing placed between vocal cords. Stage 2, removal of spacer
1.) diagnostic larynostomy
CPT code
2.) laryngotoplasty, two stages, for repair of congenital laryngeal web, removal of spacer
CPT code
3.) Emergency establishment of positive airway by means of endoctracheal intubation
CPT code:
4.) subtotal supraglottic laryngectomy with removal of adjacent lymph nodes and tissue due to a primary malignant neoplasm of glossoespiglottic folds
CPT code:
5.) Pharyngolaryngectomy with radical neck dissection for a primary malignant neoplasm of the pharyngeal region:
CPT code
planned or performed as emergency procedure
planned tracheostomy
for prolonged ventilation support, beyond the level of support that can be provided by endotracheal intubation or when a patient cannot tolerate an endotracheal tube.
emrgency transtracheal tracheostomy
transverse (across) incision used in a transtracheal approach between cricoid cartilage and the sternal notch
cricothyroid membrane tracheostomy
vertical incision
Introduction category (31715-31730)
catheterization, instillation, injection, and aspiration of the trachea and the placement of tubes into trachea
bronchographic procedures
may include instillation of contrast material into larynx to improve viewing, the contrast material is suspended in a gas (which contains radiant energy) that the patient inhales
bronchographic procedure codes
radiology section codes are reported in conjunction with inject of contrast material
unilateral bronchography with contrast material injection
code 31899 for service of injection the contrast material into the trachea
71040 for supervision and interpetation of unilateral bronchography
not bundled, report each component of service separately
trachea and bronchi excision/repair
include plastic repairs such as tracheoplasty and bronchioplasty,
surgical repair of damaged trachea (may involve reconstruction of trachea using grafts or splints formed from cartilage taken from other area of the body or use of prosthesis
repair of the bronchus which may involve grafting repair or stents, a chest tube for draining which is bundled into code. The GRAFTING procedure is not bundled and would be coded separately (31770)
1) Emergency tracheostomy, cricothyroid approach
CPT code:
2) Excision of a tumor of the trachea, cervical
CPT code:
3) transtracheal injection for bronchography (code only the injection procedure)
CPT Code
4) Planned tracheostomy in 47 year old patient with acute respiratory failure
CPT code
5) catheterization with bronchial brush biopsy for bronchiolitis, acute.
CPT code
surgical incision into chest wall and opening the area to view by surgeon
Thoracotomy coding
codes divided according to reason for procedure (biopsy, control of bleeding, cyst removal, foreign body removal, or cardiac massage)
Chest tube insertion bundled into thoracotomy codes
removal of parietal pleura by opening chest, using rib spreader.
Not coded if bundled into major procedure
pneumonectomy with pleurectomy
pleurectomy bundled with pneumonectomy code
Percutaneous needle lung or mediastinum biopsy
often under radiologic guidance for correct placement of needle. biopsy code (32405)
withdrawal of fluid from the lung by means of aspirating needle (
air or gas in pleural cavity, occurs when lung is traumatically ruptured or emphysematous bulla ruptures
thoracic cavity
collapsed lung
air pressure increases in thoracic cavity, pressure on lung can result in lung collapase, surgeon withdraws air to allow the lung to reinflate
removal of lung coding
based on how much of lung removed, segmentectomy for one segment, lobectomy for one lobe, bilobectomy for two lobes, total pneumonectomy for entire lung as well as extent of procedure and approach
removal of one lung segment
removal of one lobe
removal of two lobes
total pneumonectomy
entire lung
removal/repair of part of bronchus during lobectomy or segmentectomy
code service with add-on code 32501
withdraw fluid from pleural space that has accumulated (from congestive heart failure, pneumonia, TB or carcinoma)
chest tube insertion
may be inserted using thoracentesis as an indwelling method of draining the accumulated fluid in the pleural space
pleural effusion
accumulated fluid in the pleural space
multichamber water-seal suction tube
tube used to withdraw fluid pneumothorax, hemothorax, pleural effusion (conditions due to trauma, secondary disease process, or occurs sponatenously)
portion of interal skeletal support removed to treat a condition in which pus chronically collects in the chest cavity, requires extensive resection of membrane lining chest cavity
chronic thoracic empyema
chronic collection of pus in chest cavity
coding thoracoplasty
code 32905 thoracoplasty refers to all stages, subsequent stages for removal of packing and are bundled into the surgical code
procedure to separate the inside of the chest cavity from the lung to permit the lung to collapse, originally a treatment for tuberculosis, now used in pleural disease evaluation, debridemen of chronic emphysema and more
pneumothorax injection
therapeutic procedure inserting a needle into pleural cavity and injecting air, increasing pressure and lung partially collapses. A Tuberculosis treatment. Chest tube inserted for further injections of air and is bundled into procedure.
1) thoracotomy for exploration
CPT code
2) percutaneous needle lung biopsy
CPT code
3) lobectomy and bronchoplasty performed at same surgical session
CPT code:
4) resection of an apical malignant lung neoplasm
CPT code
5) pneumonostomy with open drainage of absess (pulmonary necrosis
CPT code