Inpatient Facility Coding & Compliance Alert

Recent RAC audits showed that coding for closed biopsy of the lung is a hot button for many hospitals. Follow these 3 tips to be sure you're choosing the correct code every time.

Tip 1: Understand the differences. You have two diagnosis options when reporting closed biopsy of the lung:

• 33.24 – Closed (endoscopic) biopsy of bronchus
• 33.27 – Closed endoscopic biopsy of lung.

Key: You must know the anatomic site of the biopsy. If the physician doesn't clearly document whether he biopsied the bronchus or another area of the lung, you'll have to query for more information before moving further.
Tip 2: Confirm the type of biopsy. All biopsies are not the same, even when they're performed in the same anatomic site. For example, documentation stating "biopsy of right lower lobe" doesn't automatically mean the surgeon completed a transbronchial lung biopsy. He might actually have completed a biopsy in the right lower lobe bronchus of the lung, not the lung itself. That could mean the difference in reporting 33.24 instead of 33.27.

Tip 3: Question biopsy tissue absence. The pathology report following biopsy sometimes includes lung tissue – but sometimes doesn't. The absence of tissue could be due to a couple of factors.

Explanation: During a bronchial biopsy, the physician inserts a bronchoscope through the nose and throat into the bronchial tube. He can visualize the tissue and knows he's performing a bronchial biopsy. The process is more complex for a lung biopsy. The physician uses forceps and fluoroscopic guidance to puncture the bronchus and biopsy the lung. He's not able to visualize the tissue before extraction, so microscope evaluation will confirm whether he has a bronchial or lung sample. The absence of tissue on the pathology specimen could mean that the surgeon performed a lung biopsy that failed. Remember, however, that you should still report a failed procedure as if it were performed.