Pulmonology Coding Alert

Pulmonology coders have two new bronchoscopy-related codes to look forward to in 2004. CPT introduces 31632 and 31633, which will allow you to report multiple transbronchial biopsies without using modifiers -22 or -59. Pick Add-On Codes Instead of Modifiers When your pulmonologist performs multiple transbronchial lung and aspiration biopsies during broncoscopy, capture the physician's additional work with the following add-on codes: +31632 - Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy(s), each additional lobe (list separately in addition to code for primary procedure) +31633 - ... with transbronchial needle aspiration biopsy(s), each additional lobe (list separately in addition to code for primary procedure). Codes 31632 and 31633 should make your life easier because you no longer have to rely on modifiers and extensive documentation to attempt to get the physician paid for additional lung and aspiration biopsies, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Prior to CPT 2004, you may have attached modifier -22 (Unusual procedural services) to base codes 31628 (... with transbronchial lung biopsy[s], single lobe) and 31629 (... with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) to report multiple biopsies. Some coders tried to bill the codes twice using modifier -59 (Distinct procedural service), Pohlig says. "Often, these attempts were unsuccessful in recovering additional monies," she adds. Tip: Because 31632 and 31633 are add-on codes, you should no longer use modifiers when you report them, Pohlig says. Match 31632 and 31633 With Correct Procedures To report the pulmonologist's additional transbronchial biopsies in 2004, you should use 31632 along with 31628 for the initial transbronchial lung biopsies, and 31633 in addition to 31629 for the initial needle aspiration biopsies, says Laurie Castillo, MA, CPC, CPC-H, CCS-P, president of Professional Coding and Compliance Consulting in Manassas, Va. For example, if the physician performs multiple transbronchial lung biopsies on a patient, you would assign 31628 for the primary procedure and use add-on code 31632 for the biopsy in each additional lobe. You should never report 31632 or 31633 alone or attach modifier -51 (Multiple procedures) to the codes. You don't need the modifier, because 31632 and 31633 are add-on codes. Also, assign 31632 and 31633 only once per additional lobe that your pulmonologist treats, regardless of the number of transbronchial biopsies the physician performed within that lobe. For instance, the pulmonologist performs one transbronchial biopsy in the right-upper lobe, two biopsies in the left-upper lobe, and one in the left-lower lobe. You would report 31628 for the right-upper lobe biopsy, 31632 once for the left-upper lobe procedures and once for the left-lower biopsy (31628, 31632 x 2). Use [...]