General Surgery Coding Alert

Question: Can I bill bronchoscopy with thoracotomy?

North Carolina Subscriber

Answer: A surgeon may perform (and separately bill for) bronchoscopy (31622, Bronchoscopy [rigid or flexible]; diagnostic, with or without cell washing [separate procedure]) for diagnostic purposes and recommend thoracic surgery when the scope identifies a problem. Chapter six of the National Correct Coding Initiative (NCCI) clearly states, "If an endoscopy is performed for purposes of an initial diagnosis on the same day as the open procedure, the endoscopy is separately reported" [emphasis added]. In other words, if the scope uncovers the problem that leads to the decision for surgery, you may report it separately.
 
For example, the surgeon provides a bronchoscopy that reveals the patient has a lobar foreign-body obstruction. After unsuccessfully attempting to remove the foreign body bronchoscopically, the surgeon performs a thoracotomy. In this case, because the surgeon's endoscopic effort failed and he plans to perform a thoracotomy, you may report the diagnostic bronchoscopy separately in addition to the thoracotomy. To underscore the "planned" aspect of the thoracotomy and in accordance with NCCI instructions, you should append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to the appropriate thoracotomy code (for example, 32151, Thoracotomy, major; with removal of intrapulmonary foreign body). This is not a simple "converted" surgery, such as a conversion from a closed to open procedure, because the scope uncovered the problem that led to the physician's decision for surgery.
 
If the surgeon decides to repeat the bronchoscopy after the patient receives general anesthesia to confirm the surgical approach to the foreign body, you should not bill for this "confirmatory" bronchoscopy. And, do not separately bill if the surgeon performs a bronchoscopy after surgery for purposes of evaluation.
 
You may not report a separate scope to establish anatomic landmarks, the extent of disease, etc., if the surgeon has already provided and billed a diagnostic scope for diagnosis and biopsy. "If an endoscopic procedure is done as part of an open procedure, it is not separately reported," according to NCCI.