Pulmonology Coding Alert

What do you have to say from the quiz on page 3? Coding bronchoscopy procedures can be a real test, especially with the existence of many different bronchoscopy codes. Be able to tell when a bronchoscopy procedure calls for unfuzzy coding and when the coding becomes more challenging.

Answer 1: A. Usually, you'd use the basic bronchoscopy code 31622 (Bronchoscopy, rigid or flexible; diagnostic, with or without cell washing; separate procedure) for a simple suctioning of the mucus.

What happens: Diagnostic bronchoscopy involves a pulmonologist inserting a bronchoscope and visualizing the vocal cords, tracheobronchial tree, major lobar, and segmental bronchi for abnormalities, says Jeff Berman, MD, FCCP, executive director of the Florida Pulmonary Society.

Often, physicians opt for diagnostic bronchoscopy as an initial procedure to diagnose or manage the presenting problem. The results from the bronchoscopy may tell a physician whether there is a need for further intervention. It's always a good choice to make 31622 as your "base" bronchoscopy code, says Jill Young, CPC-EDS, president of Young Medical Consulting LLC in East Lansing, Michigan.

Another way: You can report 31645 (Bronchoscopy [rigid or flexible]; with therapeutic aspiration of tracheobronchial tree, initial [e.g., drainage of lung abscess]) when the pulmonologist provides more detail in the procedure report. For example, 31645 would be appropriate with a diagnosis of total atelectasis (518.0, Collapse of the lung) due to mucus plugging.

Answer 2: B. You should report 31622 only for a diagnostic bronchoscopy when the pulmonologist did not perform any biopsy, BAL (bronchial alveolar lavage), brushing, or other intervention. If a more extensive service was rendered to the patient, pick the code that best fits the procedure -- e.g., 31625 (Bronchoscopy [rigid or flexible]; with bronchial or endobronchial biopsy[s], single or multiple sites), 31623 (Bronchoscopy [rigid or flexible]; with or without fluoroscopic guidance; with brushing or protected brushings), or 31624 (Bronchoscopy [rigid or flexible] ... with bronchial alveolar lavage), respectively.

Why: Both CPT and Medicare bundle 31622 into all other "surgical" bronchoscopy services. The code's "separate procedure" clause means you should use it only if the physician performs no other procedures during the bronchoscopy. In fact, 31622 has a "0" CCI modifier indicator, which means that it cannot be reported with any other bronchoscopy code and that you cannot use a modifier to unbundle the edit pair.

Although the series 31622-31656 is usually lumped as a "bronchoscopy code family," each code represents a separate procedure. While 31622 is the base bronchoscopy (done with or without cell washings), the rest of the codes in the series (31623-31656) pertain to the diagnostic and therapeutic measures that a pulmonologist can perform during a bronchoscopy session.

Example: A patient presents with increased cough, chest pain, and dyspnea. The pulmonologist performs a diagnostic bronchoscopy (31622), during which a lesion is discovered in the patient's right lower lobe. The pulmonologist then obtains a biopsy, washings, and brushings. You would only report codes 31625 and 31623 on the claim, which pertain to the therapeutic bronchoscopy services that the pulmonologist performed on the patient (31622 is already incorporated into the two therapeutic bronchoscopy codes).