# bronchoscopy 31625 with 31623



## vmounce (Dec 1, 2009)

I am a little confused.  I believe I can bill 31625 and 31623 together, but I am uncertain about diagnosis code to use with 31623.  The brushing are in the same areas that the biopsy was done.  Does it not have to be in different areas?  

I appreciate any info.

Below is the operative report:

OPERATIVE PROCEDURE:   After obtaining consent from the patient and explaining to her the risks of the procedure including bleeding and infection, the patient was brought to the endoscopy suite.  Topical anesthesia was achieved by instilling Hurricaine spray and viscous lidocaine in the nares and oropharynx respectively.  Conscious sedation was achieved by the anesthesiologist by giving IV Diprivan.  The bronchoscope was introduced through the right naris and advanced and the vocal cords were visualized which appeared normal.  The vocal cords were anesthetized with 2% Lidocaine.  The bronchoscope was advanced down the trachea which was normal with a sharp carina.  The trachea and carina were anesthetized with 1% Lidocaine and the lower area was instilled with 1% Lidocaine respectively. 

The bronchoscope was introduced into the right mainstem bronchus and the subsegments of the right upper, middle, and middle segment of the right lower lobe were briefly examined and were normal.  

The bronchoscope was then advanced to the left mainstem bronchus and the superior segment of the left lower lobe was completely occluded by a polypoid tumor.  The left subcarina was widened and both the lingua and upper divisions were narrowed with abnormal appearing mucosa.  The left upper lobe was significantly narrowed by the submucosal tumor.  Bronchial washings were obtained from the left upper lobe and the superior segment followed by bronchial brushings from both areas.  Several endobronchial biopsies were obtained from the superior segment and the left upper lobe.  Visualization was obscured because of bleeding and excessive mucoid secretions.


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## debrooth (Dec 16, 2009)

We've had so much trouble getting our multiple (same lung, different lobes), and our bilateral Bronchs paid in the past year, I'm not sure I should give you any advice, but here goes....  I've been to many pulmonary seminars and most lecturers have told me that even within the same lobe, to use mod -59 for another modality in that lobe.  This goes against most all other code-set "families" you can name, so I'm just repeating what I've been told.  My head is still spinning around the fact that CPT Assistant (1/2002, pg 10) tells us that "the series of codes 31623 through 31656 describe unilateral procedures."  Then, at some of these seminars, the lecturers have said that all Bronch codes are bilateral.  It may be time for me to retire.


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