Pulmonology Coding Alert

Hint: Watch modifier indicators when reporting with laryngoscopy procedures.

As you begin using the new CPT^® codes for bronchial thermoplasty and bronchial valve insertion or removal, don’t forget to check out the version 19.0 of the Correct Coding Initiative (CCI) edits — the focus of these edits is on what codes you can report when your pulmonologist performs these procedures with other bronchoscopy procedures.

Pay Attention to New Code MUE Pairings

When reporting new codes for insertion, removal of bronchial valves and codes for bronchial thermoplasty, you need to also be aware of some medically unlikely code edits (MUE) in the version 19.0 of the CCI edits.

According to the new edits, you cannot report 31615 (Tracheobronchoscopy through established tracheostomy incision) in addition to the codes listed below when your pulmonologist also performs these procedures in the same session:

31647 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve[s], initial lobe)

31648 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve[s], initial lobe)

31651 (Bronchoscopy…insertion of bronchial valve[s], each additional lobe [List separately in addition to code for primary procedure[s])

31660 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe)

31661 (Bronchoscopy…with bronchial thermoplasty, 2 or more lobes)

In addition to these above mentioned mutually-exclusive pairings, you cannot report 31648 with 31635 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body) and the bronchial thermoplasty codes (31660 and 31661) with 31640 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with excision of tumor) as these are also considered mutually-exclusive.

Heed These Bronchoscopy and Bronchial Valve Insertion Code Bundles

If you scrutinize the version 19.0 of the CCI edits for bronchoscopic procedures that your pulmonologist might perform with a bronchial valve insertion, you will notice that you cannot report 31647 with many other bronchoscopy procedures. This code bundling carries the modifier indicator ‘0’ indicating that these procedures cannot be reported together under any circumstances.

So you cannot report 31647 with the following bronchoscopy codes:

31623 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings)

31624 (…with bronchial alveolar lavage)

31625 (…with bronchial or endobronchial biopsy[s], single or multiple sites)

31626 (…with placement of fiducial markers, single or multiple)

31628 (…with transbronchial lung biopsy[s], single lobe)

31629 (…with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i])

31630 (…with tracheal/bronchial dilation or closed reduction of fracture)

31631 (…with placement of tracheal stent[s] [includes tracheal/bronchial dilation as required])

31635

31640

31641 (…with destruction of tumor or relief of stenosis by any method other than excision [e.g., laser therapy, cryotherapy])

31643 (…with placement of catheter[s] for intracavitary radioelement application)

31645 (…with therapeutic aspiration of tracheobronchial tree, initial [e.g., drainage of lung abscess])

31646 (…with therapeutic aspiration of tracheobronchial tree, subsequent)

31660

31661

Reminder: The current version of the CCI edits also bundles 31651 with 31660 and 31661. So, you cannot report 31651 with bronchial thermoplasty when your pulmonologist performs these two procedures together under any circumstances.

Observe New Code NME Pairings With These Laryngoscopy Procedures

When your pulmonologist performs a laryngoscopy and also performs a bronchial valve insertion or removal or a bronchial thermoplasty, you cannot report certain laryngoscopy procedure combinations separately as the latter procedure is considered more comprehensive as per the version 19.0 of the CCI edits.

So, check the CCI edits for prohibited pairings between 31647, 31648, 31649 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve[s], each additional lobe [List separately in addition to code for primary procedure]), 31651, 31660 or 31661 and the following laryngoscopy procedures before billing:

31525 (Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn)

31526 (Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating microscope or telescope)

31535 (Laryngoscopy, direct, operative, with biopsy)

31536 (Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope)

31540 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis)

31541 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope)

Note: If the above mentioned CCI code bundles are non-mutually exclusive, and have a code-pair modifier of "2," you can use a suitable modifier such as 59 (Distinct procedural service) to break the code bundle and report the two services together when circumstances allow. You will have to use the modifier to the code in the second column, i.e. the laryngoscopy procedural code in this case.