General Surgery Coding Alert

Surgeons who perform thoracic-related procedures may not be obtaining all the  reimbursement they are ethically entitled to for bronchoscopies performed during the same session as thoracic procedures, thoracotomy performed for diskectomy in conjunction with another specialist, transthoracic mediastinal procedures, thoracic lymphadenectomies and other situations like these.
 
Correctly documenting and coding these procedures may yield additional payment; in addition, coding guidelines outlined here can prevent general surgeons from being underpaid for their services during an operative session.
Bronchoscopy
A surgeon can perform bronchoscopy on a patient for diagnostic purposes, recommending thoracic surgery in cases where bronchoscopy identifies a problem. The surgeon may report the diagnostic bronchoscopy separately using 31622 (bronchoscopy [rigid or flexible]; diagnostic, with or without cell washing [separate procedure]), says Marcella Bucknam, CPC, a general surgery coding and reimbursement specialist and a coding instructor at Clarkson College in Omaha, Neb. It should not be billed if the bronchoscopy is performed for another reason, she says, pointing to instructions in Correct Coding Manual Version 7.3 (the latest version of the manual that compiles all changes to the Correct Coding Initiative [CCI]) that specifically discuss bronchoscopies performed during the same session as a thoracic procedure.
 
Chapter Six of CCI states that "if an endoscopy is performed for purposes of an initial diagnosis on the same day as the open procedure, the endoscopy is separately reported." However, CCI adds: "Assuming that a diagnostic bronchoscopy has already been performed for diagnosis and biopsy and the surgeon is simply evaluating for anatomic assessment for sleeve or more complex resection, the bronchoscopy would not be separately reported. Essentially, this 'scout' endoscopy represents a part of the assessment of the surgical field to establish anatomical landmarks, extent of disease, etc.  If an endoscopic procedure is done as part of an open procedure, it is not separately reported." Furthermore, when "the procedure is performed for diagnostic purposes immediately prior to a more definitive procedure, the -58 modifier [staged or related procedure or service by the same physician during the postoperative period] may be utilized to indicate that these procedures are staged or planned services."
 
Chapter Five of CCI elaborates on this scenario, citing the example of a bronchoscopy that reveals the patient has a lobar foreign body obstruction. A thoracotomy is performed, after an attempt to remove the foreign body bronchoscopically failed. "In this example, if the endoscopic effort was unsuccessful and a thoracotomy is planned, the diagnostic bronchoscopy could be separately coded in addition to the thoracotomy. The -58 modifier may be used to indicate that the diagnostic bronchoscopy and the thoracotomy are staged or planned procedures." If the surgeon "decides to repeat the bronchoscopy after induction of general anesthesia to confirm the surgical approach to the foreign body, [...]