The human respiratory system is a series of organs responsible for supplying oxygen and eliminating carbon dioxide. These organs work together to help you breathe. The primary purpose of these organs it to exchange gases as we breathe.Oxygen rich air moves into the lungs and carbon dioxide rich air moves out of the lungs as waste. The respiratory system in divided into the upper and lower respiratory tracts. The upper respiratory tract comprises of organs situated outside the chest cavity: the nose and nasal cavities, pharynx, larynx and upper trachea. The lower respiratory tract comprises of organs situated inside the chest cavity: the lower trachea, bronchi, bronchioles, alveoli, and lungs. The bronchi, bronchioles, alveoli, and lungs are located in the lungs.

 

CPT

 

Nose

Excision

Note: Codes 30110 (would normally be completed in an office visit setting) 30115 (would normally require the facilities available in a hospital) These notes were added to the CPT because coders were becoming confused about the extent of some procedures.

If the documentation states "extensive," and the doctor performed the procedure in the office, go ahead and code for the extensive procedure 30115. If there's no documentation about an extensive procedure and the doctor performed it in the hospital code 30110 for the simple excision.

30110 and 30115 is to be reported once even if more than 1 polyp is removed because there is an s in paretheses

If a rhinectomy is performed (30150- 30160) closure or reconstruction of the rhinectomy can be coded from the integumentary codes

30300 is a foreign body removal performed in a single nostril usually on children

30430 secondary means these procedure was performed before

30465- is a bilateral procedure

Don't code code fracture of nasal turbinates 30930 with 30130- 30140

For fracture of the superior or middle turbinates, CPT® directs you to report unlisted procedure code 30999.

When coding for turbinates code for each turbinate. The code for excision of turbinates are not per side. You may need to code for up to 6 turbinates.

Pay attention to parenthetical notes in this section

 

ACCESSORY SINUSES

Exision codes in this section are open procedures (please don't get the codes in this section confused with the nasal scopes)

31090 3 or more sinuses received sinostomies

 

 

Nasal Endoscopies

When coding nasal endoscopies review the pathology report to verify which sinuses the tissues are being removed from. 

 

Things to consider:

How many sinuses are being examined or treated?

Was any tissue removed?

 

Review documentation to see if the procedures are being performed on both sides, Use modifier 50 if performed bilaterally

Endoscopic maxillectomy w/ antrostomy you will code 31267 (maxillary sinus is also known as antrum)

Antrostomy means a surgical opening was created to improve drainage

Sometimes an antrostomy may be document as a creation of a antral window

Surgical nasal endoscopies includes sinostomies and diagnostic endoscopy.

When a diagnostic nasal endoscopy is performed all sinuses are inspected and no individual codes will be needed.

If you read a turbinectomy and sinostomy were performed during a scope do not code seperate

31295 includes fluoroscopy

 

Pay attention to all parenthetical notes in this section

 

Larynx 

Excision

NOTE: Radical neck dissection is the removal of the larynx, and lymph nodes; it may include surrounding tissue.

 

Intubation

Emergency endotracheal may be stated as "the patient was intubated in a usual fashion" code 31500

 

Laryngoscopy

Indirect laryngoscopy- a mirrors and light is used to see the larynx (more simple than direct)

Direct laryngoscopy- a lighted scope is used to directly visualize the inside of the larynx

Note: Only use 69990 if the use of a microscope is used and not included in the code description. 

31575- 31579 is a flexible laryngoscopy

 

Tracheobronchoscopy(a bronchoscopy through tracheostomy incision) 31615 DO NOT CONFUSE WITH BRONCHSCOPY CODES

 

Tracheostomy

Verify if the tracheostomy is emergent or planned

Emergency tracheostomy is performed rarely.

 

 

Bronchoscopy

Use a HCPCS code for the device when coding 31626(Bronchoscopy... with placement of fiducial markers, single or multiple) if performed at a physicians office

Code 31627 describes computer assisted image guided navigation . do not code 76376 and 76377 seperate

Code 31620 is usually forgotten, please use code for Endobronchial ultrasound (EBUS)

31622- 31654- includes fluoroscopy

Codes 31660 and 31661 are reported based on the number of lobes treated with thermoplasty

 

Lungs and pleura 

Removal

Use code (32440) for removal of the entire lung. See codes 32480-32507 for partial removal of a lobe, two lobes, segment, wedge, or other resections.

( right lung has 3 lobes and the left lung has 2 lobes)

Introduction and Removal

The code 32551(chest tube insertion(tube thoracostomy)) is included in all thoracotomy and chest endoscopic procedures. Chest tubes are required to re- expand the lungs after those surgeries.

 

VATS

May be diagnostic or surgical

If you think that a procedure is being performed via VATS verify that is surgical and not diagnostic

If the scope is removed before the surgical part of the procedure it is not performed via VATS.

Some procedures that may be performed via surgical VATS

Lobectomy 32663

Pleurodesis 32650

Total pulmonary Decortication 32652(commonly done on patients with tuberculosis)

 

Surgical Collapse Therapy: Thoracoplasty

Do not use modifier 58 with code 32905 because it states all stages 

 

Medicine section

 

use codes 94002–94005 for ventilation management 

See pratical notes in your textbook on page 26 Codes 94060 and 94070 do not include the administration of bronchodilator in spirometry; the supply of bronchodilator and antigens should be reported with 99070 or the appropriate HCPCS Level II supply code. Highlight the parenthetical instruc- tions below both of these codes to remind you to bill for the supplies.

All pulmonary codes, with the exception of CPT® codes 94760–94762 (which are technical only) have a professional and a technical component. The appropriate modifier (26 or TC) must be added, when appropriate, to designate the service performed was for the professional or technical component only. Make a note in your CPT® codebook so you remember to add the appro- priate modifier.

 

 

Spleen

Excision

Total excision at the time of another procedure (+38102).

Introduction

When coding a splenoportography use code 38200 for injection and 75810 for supervision and interpretation.

 

Bone marrow

These codes are not your transplants. codes are used to preserve prepare and purify bone marrow stem cells prior to transplant

38204- used for donor search

38205- 38206- harvesting of bone marrow (38205 same species, 38206 self)

38207- 38215 preparation of previous harvested bone marrow cells (reports the different stages of the transplant, each code may be reported only once per day)

 

 

General

Transplantation and Post Transplantation(bone marrow)

Code 38241 if the donor is the person needing the transplant

Code 38240 when the donor is someone other than the person needing the transplant

 

Lymph Nodes and Lymphatic Channels

Incision

Sometimes it's difficult for coders to distinguish between simple drainage(38300) and extensive drainage( 38305). Please query the physician if unsure.

 

Radical Lymphadenectomy

Includes resection of all lymph nodes surrounding tissue and structures

 

Note: A sentinel node is the first lymph node or group of lymph nodes where the cancer spreads from the primary location. It is used to test to see if a cancer has spread. If the sentinel node is negative than it is likely the distal nodes are negative as well.

 

Look up

Most procedures found in this section can be found in the index exactly the way its written eg. Bronchoscopy.

 

VATS

Thoracoscopy

 

Chest exploration and evacuation of clot

Chest/exploration/ Blood vessel

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