Coding Quiz: Quiz: Beef Up Your Bronchoscopy Payment

Remember add-on codes to clarify your work

Think you've got bronchoscopy coding down pat? Whip out your trusty CPT manual, flip to the bronchoscopy codes (31622-31656), and challenge yourself with this quiz to find out.
Question #1: A 72-year-old man undergoes a diagnostic fiberoptic bronchoscopy while under conscious sedation. The physician inserts the bronchoscope through the upper airway, noting any abnormality. She then inserts the scope into the tracheobronchial tree, and when she finishes the procedure, hospital staff monitor the patient until the conscious sedation wears off. Which code should you report?
Answer #1: For this procedure, you should report 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]). "The method - whether [the bronchoscopy] is flexible or rigid - does not determine the description of the code," says Deborah Grider, CMA, CPC, CPC-H, CCS-P, CCP, president of Medical Professionals Inc. in Indianapolis.
Question #2: The patient is a 74-year-old male with a history of heavy smoking, with bilateral lung masses and weight loss. Following careful conscious sedation, the physician performs a bronchoscopy. The doctor initially attempted the procedure in the left nostril, but due to swelling mucosa, opted for the right. Vocal chord structure and function was normal. The tracheobronchial tree was normal on the right side, but the left side showed distortion. Under fluoroscopic guidance, the physician obtained biopsies of the left upper lobe mass, and performed washings and brushings. How should you report this?
Answer #2: You should report these procedures using 31625 (...with bronchial or endobronchial biopsy[s], single or multiple sites) and 31623 (...with brushing or protected brushings). If you append modifier -51 (Multiple procedures), the insurer should reimburse for both, says Nannette Orme, CPC, with Ingenix in Salt Lake City, who presented on pulmonology coding at the American Academy of Professional Coders 12th annual conference.
"You should put the 31625 before the 31623," Orme says. "Some payers are more sophisticated and will automatically take those codes and put them in the right order," so you will get full reimbursement for the more costly procedure, she says. However, if the payer is less sophisticated and you put the modifier onto the highest-valued procedure, "you've shot yourself in the foot because your highest-valued procedure's already going to be cut in half."
Best bet: Report the highest-valued procedure first, then the next highest-valued, and so on. "If your reimbursement's wrong because you billed incorrectly, that can hurt [your bottom line] a lot," Orme says.
Question #3: A 58-year-old woman has peripheral alveolar infiltrates in her right lower lobes that have remained unchanged for six weeks. The physician performs a bronchoscopy but [...]

- Published on 2004-08-23