Pulmonology Coding Alert

Hint: Report other procedures performed as the primary procedure.

When your pulmonologist uses new technology like electromagnetic navigation bronchoscopy (ENB) for facilitating other bronchoscopy procedures such as a biopsy or placement of fiducial markers, check payer rules and other guidelines that govern your reporting of the procedure to avoid denial of reimbursement.

Don’t Report 3D Reconstruction Separately

You report the ENB part of the procedure with the add-on code +31627 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation [List separately in addition to code for primary procedure{s}]). The CPT® guidelines for this add-on code specifies that you cannot report the 3D mapping procedure your pulmonologist performed independently even though it might have been done on a separate, previous calendar date of service.

So, you are not allowed to report either 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation) or 76377 (…requiring image postprocessing on an independent workstation) for the 3D reconstruction of the patient’s chest prior to performing the procedure. You will only report +31627 as the reconstruction represents part of the service described by this code.

Caveat: Many payers consider the use of navigation bronchoscopy investigational and might not cover the procedure separately if your pulmonologist performs it. So, prior to reporting ENB with +31627, check with the payer to see if the procedure is covered to avoid the risk of denial.

Report The Other Procedures as Primary Codes

The navigation code +31627 is an add-on code. Since this procedure is not performed as a standalone procedure but is usually done to facilitate the precise delivery of another bronchoscopy procedure, you should report the other procedure as the primary procedure with +31627.

Submit the appropriate bronchoscopy code(s) for the biopsies, brushings, or needle aspirations. Your options include:

• A primary bronchoscopy code (31615, 31622-31625, 31628-31631, 31635, 31636, 31638-31643); or
• Fiducial marker code (included in the code range above) (31626, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple).

Coding tip: When your pulmonologist uses ENB for the placement of fiducial markers, you report 31626 for the placement for the markers and +31627 for the navigation bronchoscopy. Your pulmonologist will usually place about four markers although sometimes the number might go up to six markers. However, irrespective of the number of markers, your pulmonologist places, you will still report only one unit of 31626 as the descriptor to the code says “single or multiple.”

Example: Your pulmonologist evaluates a 55-year-old male patient with peripheral lung lesions identified on a chest x-ray and CT scan. Your pulmonologist decides to perform an aspiration biopsy with the help of navigation bronchoscopy since the lesions were difficult to precisely access using standard bronchoscopy.

Your pulmonologist maps the patient’s chest using the CT scan and software. Using this virtual bronchoscopy, your clinician performs the bronchoscopy to enable him to guide the scope to the precise site of the lesion. He then performs an aspiration bronchoscopy of the lesion.

What to report:  You should report 31629 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) for the aspiration bronchoscopy. Remember to put this in the first line of the claim as the primary procedure. You should report +31627 as the add-on code for the ENB part of the procedure.