Pulmonology Coding Alert

31622 is often bundled into other bronchoscopy codes

When coding diagnostic bronchoscopies, you'll have to decide when to report the base bronchoscopy code and when to leave it off the claim.
  
And if you cannot recognize scenarios in which the pulmonologist performs bronchoscopy with bronchial alveolar lavage (BAL), a denial could head your way. Check out this expert advice on reporting your diagnostic bronchoscopies. Use 31622 for Diagnostic Procedures When the physician inserts a bronchoscope and visualizes the vocal cords, tracheobronchial tree, major lobar and segmental bronchi for abnormalities, this typically represents a diagnostic bronchoscopy. Code these encounters with 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]), says Jeff Berman, MD, FCCP, executive director of the Florida Pulmonary Society.

Coders should use 31622 as the "base" bronchoscopy code, says Jill Young, CPC-EDS, president of Young Medical Consulting LLC in East Lansing, Mich. Often, the physician performs the diagnostic bronchoscopy as a first attempt to diagnose or manage the presenting problem, and this may determine the need for additional intervention.

Example: A patient reports coughing up blood. The pulmonologist performs a diagnostic bronchoscopy with washing to try to find the source of the bleeding. In this instance, you should report 31622 for the service. Don't forget to link ICD-9 code 786.3 (Hemoptysis) to 31622 to prove medical necessity for the procedure.

The pulmonologist may schedule a diagnostic bronchoscopy after running other tests to check the patient's lung status. These other tests might be a chest x-ray, a computed tomography (CT) scan, or a pulmonary function test (PFT).

Example: A patient reports he has had a cough for three months. After performing spirometry with graphic record and a CT of the chest on day one, which do not pinpoint the patient's problem, the pulmonologist performs a diagnostic bronchoscopy on day two to assess the cause for the cough.

For the day-one claim, report the following:

• 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) for the spirometry

• 786.2 (Cough) linked to 94060 to represent the patient's cough.

Note: You may need to append modifier 26 (Professional component) to 94060 if the service occurs in a hospital-based office or pulmonary function laboratory.  For the day-two claim, report:

• 31622 for the bronchoscopy.

•  786.2 (Cough) linked to 31622 to represent the patient's cough. Mucous Plugs Often Prompt Bronchoscopy Patients with chronic obstructive pulmonary disease (COPD) or bronchiectasis may require diagnostic bronchoscopies so the physician can locate and treat mucous plugging, Berman says.

Example: An established patient with bronchiectasis reports complaining that he cannot breathe easily. A chest x-ray reveals an atelectasis of the right middle lobe. The pulmonologist performs a diagnostic bronchoscopy, finds that the atelectasis is secondary to a large mucous plug [...]