2021 BILLING AND CODING GUIDE THORACIC SURGERY

[Pages:7]2023 Billing and Coding Guide

Thoracic surgery

This guide is intended to aid providers in appropriate procedure code selection for Thoracic Surgery procedures. The document reflects applicable and commonly billed procedure codes as well as the unadjusted national Medicare average rates assigned to the CPT?1 code. This document is not all-inclusive, nor does it replace advice from your coding and compliance departments and/or CPT?1 coding manuals. CPT?1 code descriptions in this document have been shortened to the consumer-friendly version per the American Medical Association (AMA) guidelines.2 Note, CPT?1 consumer-friendly descriptors should not be used for clinical coding or documentation.3

HCPCS4 II codes

Level II HCPCS4 codes are primarily used to report supplies, drugs and implants that are not reported by a CPT?1 code. HCPCS codes are reported by the physician, hospital or DME provider that purchased the item, device, or supply. Different payers have different payment methods for these items.

C-codes are a series of HCPCS codes that facilities reimbursed under the Medicare Outpatient Prospective Payment System (OPPS) are required to report for eligible items and services. Medicare assigns C-codes to specific devices eligible for pass-through payment. Every year, in the OPPS rule, Medicare publishes a list of CPT?1 and HCPCS codes that are designated as device-intensive procedures. When reporting procedures on this list, facilities should capture both the CPT?1 code representing the procedure performed and the C-code representing the device used. Although C-codes only affect Medicare outpatient reimbursement, facilities may also want to report C-codes on inpatient claims if the device is not used exclusively for inpatient procedures. Medicare tracks this information and uses it in its rate-setting process. Non-OPPS facilities may report C-codes at their discretion.

HCPCS II S-codes cannot be reported to Medicare. They are used only by non-Medicare payers, which cover and price them according to their own requirements.

HCPCS4 Code

Description

A4649

Surgical supply; miscellaneous

S2900

Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)

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Procedure reimbursement

CPT?1 code

Description

Diagnostic

32096 Biopsy of fluid collection of lung

32097 Biopsy of growth of lung

32098 Biopsy of lung lining

Work RVU

Physician5

Office rate

Facility rate

Hospital outpatient6

APC SI

Rate

Ambulatory surgery6

PI

Rate

13.75 NA 13.75 NA 12.91 NA

$798

NA C

NA

$800

NA C

NA

$760

NA C

NA

NA NA NA NA NA NA

32100 Incision and exploration of chest cavity 13.75

NA

$809

NA C

NA

NA NA

32400 Needle biopsy of lining of lung

1.76

32601

Diagnostic exam of lungs, heart sac, chest cavity, or lung lining using an endoscope

5.50

32606

Biopsy of tissue of chest using an endoscope

8.39

$170 NA NA

$84 $306 $458

5072 J1

$1,500 A2

$637

5361 J1

$5,212 NA NA

5361 J1

$5,212 NA NA

32607

Biopsy of fluid collection of lung using an endoscope

5.50

NA

32608

Biopsy of growth of lung using an endoscope

6.84

NA

32609

Biopsy of lung lining using an endoscope

4.58

NA

32666

Initial removal of wedge of lung tissue using an endoscope

14.50

NA

Removal of wedge of tissue of lung

+32667 using an endoscope, each additional 3.00

NA

removal

+32668

Biopsy of wedge of lung tissue followed by partial removal of lung

3.00

NA

$306

5361 J1

$5,212 NA NA

$376

5361 J1

$5,212 NA NA

$254

5361 J1

$5,212 NA NA

$870

NA C

NA

NA NA

$155

NA C

NA

NA NA

$155

NA C

NA

NA NA

Please refer to page 5 for footnotes 2

Procedure reimbursement

CPT?1 code

Description

Excision

Physician5

Hospital outpatient6

Ambulatory surgery6

Work RVU

Office rate

Facility rate

APC

SI

Rate PI

Rate

32110

Repair of tear of lung and/or control of traumatic bleeding through chest

25.28

NA

$1,472 NA C

NA NA NA

32120

Incision of chest cavity for complications after surgery

14.39

NA

$873

NA C

NA NA NA

32141 Removal of air sac of lung through chest 27.18

NA

32150

Removal of foreign body or clot in lining of lung through chest

16.82

NA

$1,518 NA C

NA NA NA

$1,012 NA C

NA NA NA

32160 Massage of heart muscle through chest 13.10

NA

$799

NA C

NA NA NA

32440 Removal of lung

32442

Removal of lung and portion of windpipe cartilage

32480 Removal of lobe of lung

27.28

NA

$1,564 NA C

NA NA NA

56.47

NA

$3,034 NA C

NA NA NA

25.82

NA

$1,475 NA C

NA NA NA

32482 Removal of 2 lobes of lung

27.44

NA

$1,577 NA C

NA NA NA

32484 Removal of segment of lung tissue

25.38

NA

$1,428 NA C

NA NA NA

Please refer to page 5 for footnotes 3

Procedure reimbursement

CPT?1 code

Description

Physician5

Hospital outpatient6

Ambulatory surgery6

Work RVU

Office rate

Facility rate

APC

SI

Rate PI

Rate

Excision, continued

32501

Repair of lung airway and removal of

4.68

NA

segment of lung

$241

NA C

NA NA NA

32505 Initial removal of wedge of lung tissue 15.75

NA

$931

NA C

NA NA NA

32506

Removal of lung tissue wedge through chest, each additional removal

3.00

NA

32507

Removal of lung tissue wedge for diagnosis

3.00

NA

32650

Adhesion of linings of lung using an endoscope

10.83

NA

32651

Partial removal of chest cavity lining

18.78

NA

and lung lining using an endoscope

32652

Removal of chest cavity lining and lung lining using an endoscope

29.13

NA

32653

Removal of foreign body in lining of chest cavity using an endoscope

18.17

NA

32654 Control of traumatic bleeding in chest 20.52

NA

using an endoscope

32655

Removal of air sac of lung using an endoscope

16.17

NA

32656

Removal of lining of lung using an endoscope

13.26

NA

$155

NA C

NA NA NA

$155

NA C

NA NA NA

$668

NA C

NA NA NA

$1,093 NA C

NA NA NA

$1,657 NA C

NA NA NA

$1,057 NA C

NA NA NA

$1,175 NA C

NA NA NA

$957

NA C

NA NA NA

$804

NA C

NA NA NA

Please refer to page 5 for footnotes 4

Procedure reimbursement

Physician5

Hospital outpatient6

Ambulatory surgery6

CPT?1 code

Description

Work RVU

Office rate

Facility rate

APC

SI

Rate PI

Rate

Excision, continued

32659

Creation of opening or partial removal 11.94

NA

of heart sac using an endoscope

$734

NA

C

NA

NA

NA

32662

Removal of cyst or growth of chest cavity using an endoscope

14.99 NA

$893

NA

C

NA

NA

NA

32663

Exam of lung with removal of lung lobe 24.64

NA

using an endoscope

$1,393 NA

C

NA

NA

NA

32666

Initial removal of wedge of lung tissue 14.50

NA

using an endoscope

$870

NA

C

Removal of wedge of tissue of lung

+32667 using an endoscope, each additional

3.00

NA

removal

$155

NA

C

+32668 Biopsy of wedge of lung tissue followed 3.00

NA

by partial removal of lung

Please refer to page 5 for footnotes

$155

NA

C

Footnotes

NA Indicates that there is no in-office differential for these codes

SI

Indicates Status Indicator

PI

Indicates Payment Indicator

+

Add-on codes are always listed in addition to the primary procedure code

Comprehensive APCs (C-APCs)

?

Device intensive

?

Packaged Payment

RVU Indicates Relative Value Unit

NA

NA

NA

NA

NA

NA

NA

NA

NA

5

Hospital Inpatient procedure coding

ICD-10-PCS7 procedure codes are used by hospitals to report surgeries and procedures performed in the inpatient setting. For the purposes of this guide, the focus of thoracic surgery is lung procedures. This specifically includes diagnostic biopsy, local and segmental excision, lobectomy, and pneumonectomy, performed primarily for lung tumors.

ICD-10-PCS7

Description

0BDK8ZX

Extraction of Right Lung, Via Natural or Artificial Opening Endoscopic, Diagnostic

0BBL4ZZ

Excision of Left Lung, Percutaneous Endoscopic Approach

0B5J4ZZ

Destruction of Left Lower Lung Lobe, Percutaneous Endoscopic Approach

0BTF4ZZ 0BB88ZZ

Resection of Right Lower Lung Lobe, Percutaneous Endoscopic Approach

Excision of Left Upper Lobe Bronchus, via Natural or Artificial Opening Endoscopic

2023 Hospital Inpatient Medicare reimbursement

Under Medicare's MS-DRG8 methodology for hospital inpatient payment, each inpatient stay is assigned to one of about 750 diagnosis-related groups, based on the ICD-10 codes assigned to the diagnoses and procedures. Each MS-DRG8 has a relative weight that is then converted to a flat payment amount. Only one MS-DRG8 is assigned for each inpatient stay, regardless of the number of procedures performed.

The DRGs below are typically assigned for procedures related to thoracic surgery.

MS-DRG8

Description

Lung excision

163

Major Chest Procedures W MCC

164

Major Chest Procedures W CC

165

Major Chest Procedures W/O CC/MCC

Other lung biopsy

166

Other Respiratory System O.R. Procedures W MCC

167

Other Respiratory System O.R. Procedures W CC

168

Other Respiratory System O.R. Procedures W/O CC/MCC

Rate

$33,225 $17,716 $13,218

$25,146 $13,041 $9,724

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References

1. CPT copyright 2022 American Medical Association. All rights reserved. CPT? is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

2. American Medical Association. Consumer and Clinician Descriptors in CPT Data Files. . Accessed January 11, 2023

3. Centers for Medicare and Medicaid Services. Medicare Physician and Other Practitioners by Geography and Service Data Dictionary: HCPCS Description. . Accessed January, 11 2023.

4. Centers for Medicare and Medicaid Services. Healthcare Common Procedure Coding System (HCPCS) Quartly Update. . Accessed January 11, 2023

5. Centers for Medicare and Medicaid Services. Medicare Program; CY 2023 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Federal Register (87 Fed. Reg. No. 222 69404-70699) . 2023 National Physician Fee Schedule Relative Value File January Release . Published Jan 4, 2023.

6. Centers for Medicare and Medicaid Services. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Final Rule, Federal Register (87 Fed. Reg. No. 225 71748-72310), , Addenda B, AA. published November 23, 2022. January 2023 ASC Approved HCPCS Code and Payment Rates. . Published January, 9, 2023

7. Centers for Medicare and Medicaid Services. International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS). . Accessed January 11, 2023

8. Centers for Medicare and Medicaid Services. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the LongTerm Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2022 Rates; Final Rule, Federal Register (87 Fed. Reg. No. 153 48780-49499), Published August 10, 2022.

Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules and regulations. The provider has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage and payment policies. This document provides assistance for FDA approved or cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, the FDA cleared or approved labeling (e.g., instructions for use, operator's manual or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service.

Resources

Medtronic Reimbursement Support is available to assist you with your coding and reimbursement questions. If your coding or reimbursement questions were not answered in this guide, please check out these additional resources:

Visit our website:

Email us: rs.MedtronicMedicalSurgicalReimbursement@

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