General Surgery Coding Alert

Question: How should we report the following case: “Diagnostic bronchoscopy procedure: noted copious amounts of mucopurulent brownish material in airways, removed samples with suction and lavage and sent to lab for routine studies”?

Texas Subscriber

Answer: Because the procedure described is a diagnostic bronchoscopy and the surgeon uses the lavage to remove material for further study, the best code choice is 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]).

A similar code might look tempting to you, especially because it uses the term “lavage” that your surgeon used in the op report: 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage).

Avoid confusion: One of the key distinctions between these codes is bronchial alveolar lavage (BAL) versus cell washing. The BAL procedure typically involves instillation of larger quantities of saline than the surgeon would use for a simple cell washing that is often done as part of a diagnostic bronchoscopy. The cell washing might be used with a biopsy and bronchial brushing to evaluate for malignancy, for instance. The BAL is often done for treatment to remove mucous plugs in patients with unexplained infiltrates.

Tip: Identifying the right code is often easier if you go through the procedure notes in detail. If your surgeon has performed a bronchoalveolar lavage, you might see the op notes with details such as “infused 75 ml of saline and suctioned back 30 ml of fluid”. Such details would indicate that the appropriate procedure code is 31624.