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)
1
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
6
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@
7
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