Otolaryngology Coding Alert

Question: When the doctor performs a direct laryngoscopy with biopsy (31535) he may proceed to do a bronchoscopy for diagnostic purposes (31622) to make sure there is no further pathology. The Corrective Coding Initiative (CCI) edits say that 31535 is bundled in with 31622. Can these be billed together, and what are the proper modifiers to use? Does there have to be a separate diagnosis or will the diagnosis for the laryngoscopy be sufficient?

Joyce Rucker, CPC
Vanderbilt Abstaction, Tenn.

Answer: If the bronchoscopy was performed to look for more lesions in another area and not simply to aid in the biopsy, then both 31535 and 31622 may be billed, says Susan Callaway-Stradley, CPC, CCS-P, a coding reimbursement specialist and educator in North Augusta, S.C. The 31622 would require modifier -59 (distinct procedural service) attached to indicate that the procedure was to look for more lesions in another area, not just to aid in the biopsy.

A separate diagnosis for the bronchoscopy also would be required. For example, says Emily Hill, PA-C, CPC, the managing partner of Hill and Associates, a coding and reimbursement firm in Wilmington, N.C., if the patient has lung problems and persistent hoarseness, the hoarseness diagnosis would correspond to the 31535, while the bronchoscopy would use the diagnosed lung problems. Two real, separate studies resulting from both procedures should be documented, Hill adds.

Note: Even though 31535 is bundled into 31622, the 31535 reimburses at a higher rate (31535, 7.29 RVUs; 31622, 6.12 RVUs). Consequently, if the circumstances that might allow you to charge for both procedures arent there, you should report the 31535 rather than the 31622. This, incidentally, follows coding guidelines that state when diagnostic and surgical procedures are performed during the same operative session, only the surgical procedures should be billed.