Pulmonology Coding Alert

“Bronchial thermoplasty is a non-drug, minimally invasive procedure that a pulmonologist might perform on an adult patient with severe asthma when the condition isn’t responding to any form of medication or is uncontrollable,” says Christy Lee, CPC, CRC, CPEDC, remote medical coder, at the Sansum Clinic in Santa Barbara, California.

During the procedure, the pulmonologist guides a bronchoscope through the patient’s mouth and down into the bronchi of the lungs. Once the bronchoscope is in position, the physician inserts a catheter into the patient’s lungs. In small sections, the catheter produces thermal heat to shrink the smooth muscle.

“All the therapies that are geared towards asthma are trying to help stop the inflammation, keep you from having an allergic reaction, or try to dilate the muscles so that the airways stay open. But [bronchial thermoplasty] is the only one that tries to actually target the muscle and tries to make it not work so it can’t constrict,” says D. Kyle Hogarth, MD, professor of medicine, at The University of Chicago Medicine in Chicago.

Base Your Code Selection on the Number of Lobes

A pulmonologist typically performs bronchial thermoplasty in three separate procedures approximately three weeks apart. Separating the treatments into multiple sessions helps reduce the risk of diffuse airway edema (swelling) or inducing an asthma exacerbation. Assigning the correct bronchial thermoplasty code is specific to the number of lung lobes treated in a single session.

For example, you’ll assign 31660 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe) if the pulmonologist treats one lobe during a session, whereas you’ll assign 31661 (… with bronchial thermoplasty, 2 or more lobes) if two or more lung lobes are treated.

Guidance codes need not apply: “Fluoroscopic guidance is included in both 31660 and 31661,” Lee says. Since the image guidance service is included in the procedures, you should not assign a separate fluoroscopic guidance code.

Put Your Skills to the Test

Examine the following scenarios to see if you can choose the correct bronchial thermoplasty code for each one.

Scenario 1: A patient diagnosed with severe asthma presents to your pulmonology clinic for a bronchial thermoplasty procedure. The pulmonologist performs the treatment on the middle lobe of the patient’s right lung.

For this scenario, you’ll assign 31660 for the bronchial thermoplasty procedure. The descriptor for 31660 indicates the code will be assigned to procedures performed on only one lobe of the patient’s lungs.

Scenario 2: A patient diagnosed with severe asthma has undergone several treatment options for several years. The patient’s asthma is not responding to medications, inhalers, or other therapies, so the patient’s pulmonologist orders bronchial thermoplasty. The patient returns the following week, and the physician performs the bronchial thermoplasty on the right superior, middle, and inferior lobes.

In this scenario, you’ll assign 31661 to report the bronchial thermoplasty procedure. CPT^® code 31661’s descriptor indicates the code is designated for bronchial thermoplasty procedures performed on two or more lobes. Since the physician treated three lobes total during the session, 31661 is the correct code to assign.

Scenario 3: During one session, the pulmonologist performs a bronchial thermoplasty on the superior lobe of the right lung. The patient returned to the pulmonology practice two days later, where the physician treated the inferior lobes of both lungs.

In this scenario, you’ll use both bronchial thermoplasty CPT^® codes to report the procedures. For the first session, you’ll assign 31660 since the physician treated only one lobe at that time. Then you’ll assign 31661 for the second session because the provider treated two lobes.

Remember: CPT^® code 31661 is a standalone code and doesn’t need a primary procedure code to be reported. For example, if a provider performs a bronchial thermoplasty on four lobes, you don’t need to report 31660 for the first lobe and 31661 for any additional lobes. You’ll assign only 31661 for the four total lobes treated.