Pulmonology Coding Alert

4 scenarios help you improve your bronchoscopy skills

Before you report any bronchoscopy procedures, look to your documentation to see if you should report add-on codes to clarify the work your pulmonologist completed.

Take a look at these four common bronchoscopy coding scenarios to test your skill in applying codes 31622-31656. Write down your responses before looking to the correct answers.

Scenario 1: A 72-year-old man undergoes a diagnostic fiberoptic bronchoscopy while under conscious sedation. The pulmonologist inserts the bronchoscope through the upper airway, noting any abnormality. She then inserts the scope into the tracheobronchial tree.When she finishes the procedure, office staff monitor the patient until the conscious sedation wears off.

Which code should you report?

Scenario 2: The patient is a 74-year-old man with a history of heavy smoking, with bilateral lung masses and weight loss. Following careful conscious sedation, the pulmonologist performs a bronchoscopy. The doctor initially attempted the procedure in the left nostril, but due to swelling mucosa, opted for the right. Vocal chord structure and function was normal. The tracheobronchial tree was normal on the right side, but the left side showed a mass obstructing the upper lobe.

Under fluoroscopic guidance, the pulmonologist obtained biopsies of the left upper lobe mass and performed washings and brushings.

How should you report this?

Scenario 3: A 58-year-old woman has peripheral alveolar infiltrates in her right lower lobes that have remained unchanged for six weeks. The pulmonologist performs a bronchoscopy but does not visualize any bronchial mucosal lesions.

Under fluoroscopic guidance, the pulmonologist inserts biopsy forceps into the area of infiltrate in the peripheral right lower lobe. He obtains three to six lung biopsies, each with fluoroscopic guidance of the biopsy forceps, and a transbronchial biopsy on expiration. He then submits the specimens to the lab.

Which code should you report for this procedure?

Scenario 4: A patient has a perihilar 0.5-cm nodule in the right lower lobe and a 1.5-cm subcarinal lymph node. The pulmonologist performs a bronchoscopy and passes a transbronchial biopsy needle through the carina. He then obtains aspiration biopsies from the subcarinal lymph node.

The pulmonologist couldn't use a biopsy forceps to reach the perihilar nodule in the right lower lobe and, under fluoroscopic guidance, obtains two transbronchial needle aspiration biopsies. He submits biopsy specimens separately from the two anatomic sites.

How should you report this procedure?