Pulmonology Coding Alert

Answer 1: For this procedure, you should report 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]). "The method - whether [the bronchoscopy] is flexible or rigid - does not determine the description of the code," says Deborah Grider, CMA, CPC, CPC-H, CCS-P, CCP, president of Medical Professionals Inc. in Indianapolis. Answer 2: You should report these procedures using 31625 (... with bronchial or endobronchial biopsy[s], single or multiple sites) and 31623 (... with brushing or protected brushings).

If you append modifier -51 (Multiple procedures), the insurer should reimburse for both, says Nannette Orme, CPC, with Ingenix in Salt Lake City, who presented on pulmonology coding at the American Academy of Professional Coders 12th annual conference in Atlanta.

"You should put the 31625 before the 31623," Orme says. "Some payers are more sophisticated and will automatically take those codes and put them in the right order," so you will get full reimbursement for the more costly procedure, she says. However, if the payer is less sophisticated and you put the modifier onto the highest-valued procedure, "you've shot yourself in the foot, because your highest-valued procedure's already going to be cut in half."

Best bet: Report the highest-valued procedure first, then the next highest-valued, and so on. "If your reimbursement's wrong because you billed incorrectly, that can hurt [your bottom line] a lot," Orme says. Answer 3: For this procedure, you should report 31628 (... with transbronchial lung biopsy[s], single lobe). "Biopsies are obtained in one lobe with fluoroscopic guidance, and even though there are three biopsies in one lobe, you should only report the bronchoscopy once," Grider says. You should also remember that according to CPT, "to report transbronchial lung biopsies on an additional lobe, use +31632 (... with transbronchial lung biopsy[s], each additional lobe [list separately in addition to code for primary procedure])." Answer 4: You should report this service with 31629 (... with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) for the aspiration biopsies from the subcarinal lymph node, and +31633 (... with transbronchial needle aspiration biopsy[s], each additional lobe [list separately in addition to code for primary procedure]) for the two transbronchial needle aspiration biopsies in the right lower lobe.

Since the two procedures are in different areas, you should report both codes. Even though the pulmonologist obtained two specimens from the right lower lobe via needle aspiration, you only use 31633 once - regardless of the number of specimens the physician obtained, Grider says.