CPT® Code 89220

Official Description

Sputum, obtaining specimen, aerosol induced technique (separate procedure)

Common Language Description

The procedure described by CPT® Code 89220 involves the collection of a sputum specimen using a non-invasive aerosol induced technique. This method is particularly beneficial as it yields sputum samples that are enriched with mucin protein and degraded DNA products from the peripheral airways, which can be more informative than samples obtained through bronchoalveolar lavage. The examination of these sputum samples plays a crucial role in diagnosing various respiratory conditions, including asthma, chronic obstructive pulmonary disease (COPD), malignancies, and infections caused by bacteria, viruses, or fungi. Prior to the procedure, patients may receive pretreatment with albuterol or a similar beta 2-agonist to minimize the risk of bronchospasm during the sputum induction process. The procedure utilizes an ultrasonic nebulizer, which is filled with a suitable solution such as saline, distilled water, glucose water, or a surfactant agent. This nebulizer is connected to the patient through tubing and a mask, allowing the patient to inhale a fine mist that penetrates deep into the lungs. The treatment typically lasts between 5 to 20 minutes, during which the patient may experience coughing that helps to mobilize respiratory secretions, which are then expectorated into a collection cup for further analysis.

1. Indications

The procedure for obtaining a sputum specimen using an aerosol induced technique is indicated for the following conditions:

Asthma - To assist in the diagnosis and management of asthma by analyzing the sputum for inflammatory markers.
Chronic Obstructive Pulmonary Disease (COPD) - To evaluate the presence of infections or inflammatory processes in patients with COPD.
Malignancies - To help identify cancerous cells in the respiratory tract through sputum cytology.
Bacterial Infections - To detect and identify bacterial pathogens in respiratory secretions.
Viral Infections - To aid in the diagnosis of viral infections affecting the respiratory system.
Fungal Infections - To identify fungal pathogens that may be present in the lungs.

2. Procedure

The procedure for obtaining a sputum specimen using the aerosol induced technique involves several key steps:

Step 1: Patient Preparation - The patient is prepared for the procedure, which may include a review of their medical history and any necessary pretreatment with albuterol or a similar beta 2-agonist to reduce the risk of bronchospasm during the procedure.
Step 2: Setup of the Ultrasonic Nebulizer - An ultrasonic nebulizer is filled with an appropriate solution, such as saline, distilled water, glucose water, or a surfactant agent. The nebulizer is then connected to the patient using tubing and a mask to facilitate inhalation.
Step 3: Induction of Sputum - The nebulizer is activated, producing a fine mist that the patient inhales deeply into their lungs. This process typically lasts between 5 to 20 minutes, during which the patient may experience coughing as respiratory secretions are mobilized.
Step 4: Collection of Sputum - As the patient coughs, the mobilized respiratory secretions are expectorated into a collection cup, which is then sealed for laboratory analysis.

3. Post-Procedure

After the sputum specimen has been collected, the patient may be monitored for any immediate adverse reactions, particularly if they experienced significant coughing during the procedure. There are generally no specific post-procedure care requirements, but patients should be advised to report any unusual symptoms or discomfort. The collected sputum sample is sent to the laboratory for analysis, where it will be examined for the presence of inflammatory cells, pathogens, or other diagnostic markers relevant to the patient's respiratory condition.

Short Descr	SPUTUM SPECIMEN COLLECTION
Medium Descr	SPUTUM OBTAINING SPEC AEROSOL INDUCED TX SPX
Long Descr	Sputum, obtaining specimen, aerosol induced technique (separate procedure)
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	3 - Technical Component Only Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	STV-Packaged Codes
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T1G - Lab tests - other (Medicare fee schedule)
MUE	2
CCS Clinical Classification	235 - Other Laboratory

Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.

Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.