1. Chapter Nine
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2. Chapter 9: Respiratory System
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.
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3. Subheadings Usually include: Incision Excision Introduction Endoscopy
Repair
Destruction
Other Procedures
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4. 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 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)
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5. 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.
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6. 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.
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7. Respiratory (in the Medicine Section)
: 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)
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8. Spirometry (94010-94070) Measures breathing capacity
Spirogram
Also used as therapy
Usually performed by technician under supervision of physician
Patient-initiated ( )
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.
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9. 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)
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10. 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)
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11. 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.
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12. 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)
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13. 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 (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.
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14. 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 (washout) or (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)
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15. 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.
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16. 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)
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17. 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.
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18. CPT Index Pulmonary: Diagnostic Therapeutic
The pulmonology codes are divided into two subsections in the CPT index: diagnostic and therapeutic.
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19. Conclusion
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