Pulmonology Coding Alert

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.

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).

CPT also revised four code descriptions to provide you with greater specificity when reporting broncho-scopic procedures:

In 2004, three pulmonology-related surgical procedures no longer carry "starred" designations, which means you should not bill an E/M service within the procedure's global period. CPT removed stars from the following codes:

When a procedure carries a star, it means that a global package does not apply to the procedure. For example, prior to CPT 2004, you could have theoretically reported the physician's thoracentesis services (32000) one day, and then a follow-up E/M service, such as 99214 (Office or other outpatient visit ... established patient ...), on the same day.

Medicare and many other private insurers, however, would bundle the two services and not pay for the E/M service without a modifier, Pohlig says.

Removing the "starred procedure" designation makes coding 32000, 32400 and 32420 with E/M services more consistent with insurer guidelines, Pohlig adds.

In addition, CPT deleted a "starred" E/M code. You can no longer report E/M code 99025 (Initial [new patient] visit when starred surgical procedure constitutes major service at that visit) in 2004.

Typically, coders reported 99025 when the physician performed an initial visit on the same day as a primary procedure, such as 32420 (Pneumocentesis, puncture of lung for aspiration).