Pulmonology Coding Alert

Decipher when to report 31629 along with 31652 or 31653.

The new endobronchial ultrasound (EBUS) codes came in early this year, but confusion reigns about appropriate coding when using them in combination with other regular bronchoscopy codes. Make sure you know how to report multiple EBUs services on same day.

Basics: The three EBUS codes report primary rigid or flexible bronchoscopy for diagnostic or therapeutic intervention, that includes endobronchial ultrasound to biopsy suspicious lesions in the respiratory tract or aspirate fluid for diagnostic analysis.

“EBUS is becoming more utilized by pulmonary physicians during bronchoscopy, so expect to use this code more often, and become familiar how to bill it,” says Jeff Berman, MD, FCCP,  executive director of the Florida Pulmonary Society.

These codes specify the number of lesions or samples to be taken and the location of the lesions (hilar, mediastinal, or peripheral) using ultrasound guidance in the performance of a rigid or flexible bronchoscopy.

• 31652 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures)
• 31653 (…with endobronchial ultrasound [EBUS] guided transtracheal and/or transbronchial sampling [e.g., aspiration[s]/biopsy[ies]], 3 or more mediastinal and/or hilar lymph node stations or structures)
• +31654 (…with transendoscopic endobronchial ultrasound [EBUS] during bronchoscopic diagnostic or therapeutic intervention[s] for peripheral lesion[s] [List separately in addition to code for primary procedure(s)])

What’s included: In this procedure, the provider uses fluoroscopy to guide advancement of the endoscope and passes an ultrasound transducer through the bronchoscope to guide the biopsy or aspiration. This code includes imaging guidance, so imaging should not be reported separately.

Caveat: “More carriers are recognizing this as a payable procedure,” Berman says. However some payers may consider endobronchial ultrasound investigational, so check with the payer to determine their coverage. Even then, you should still report the procedure for statistical purposes.

“Be aware of any charges that may inadvertently be passed onto the patient,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.

When is it appropriate to use 31629 with 31652 and 31654?

You also have CPT^® code 31629 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]). Can you report the EBUS along with this code?

Know this: The CPT^® code 31629 is for diagnostic rigid or flexible bronchoscopy, where the provider obtains one or more needle biopsy samples from the lung. He may or may not use fluoroscopic guidance for this service. This procedure is different from EBUS in that EBUS entail the use of endobronchial ultrasound as well.

The issue: Both 31652 and 31653 include needle sampling as a part of the work. If your provider performed the bronchoscopy only to carry out the sampling of the hilar/mediastinal node, it would be inappropriate to include 31629, because your EBUS codes would already cover that part of the procedure as well.

The only possibility of coding 31629 would arise in a case when your provider first performs a needle biopsy of a part of trachea, main stem bronchi or lobar bronchi, and then decides to perform a detailed EBUS to pick up biopsy samples from mediastinal or hilar lymph nodes. Depending on the number of lymph nodes your provider targets for sampling, you will choose from 31652 or 31653.

As for the EBUS code +31654, “[it] is an add-on code that is only inclusive of EBUS provider use during peripheral lesion interventions,” Pohlig explains. You need to report it “with another primary code that represents the related services,” she adds.

Remember: You may report 31629 only once irrespective of the number of transbronchial needle aspiration biopsies your provider performed in the upper airway or in a lobe.

Final takeaway: “While EBUS coding should have become easier to report, it is often confusing when multiple service are performed on the same day,” Pohlig says.

Pohlig advises that to be successful, you need to make sure to identify a check-list of EBUS service:

• Tissue sampled: node or peripheral lesion
• Location of sample: mediastinal/hilar/subcarinal/paratracheal
• Method: transbronchial and EBUS
• Number of samples: <2 re > 3

Note: If you wish to know more about the EBUs codes, read “CPT^® 2016: New EBUS Codes Lead These Pulmonology Code Additions, Revisions, and Deletions” in Pulmonology Coding Alert, Vol. 16, No. 11.