Pulmonology Coding Alert
How to Apply the Multiple-Endoscopy Rule
Question: Which codes are best for a bronchoscopy to get optimum reimbursement? We have been using 31628 (Bronchoscopy [rigid or flexible]; with transbronchial lung biopsy, with or without fluoroscopic guidance), 31623 (... with brushing or protected brushings) with modifier -51 (Multiple procedures), and 31629 (... with transbronchial needle aspiration biopsy) with modifier -51. California Subscriber Answer: To get optimum reimbursement for the medically necessary services you have performed, you must know Medicare's multiple-endoscopy payment rule. When multiple endoscopies are performed, Medicare pays 100 percent of the highest-valued procedure. Any other procedures are paid at the allowable fee minus the base (diagnostic) fee, such as 31622 in the case of broncho-scopies. Payment for the base (diagnostic) procedure is included in the payment for the highest-valued procedure. To maximize payment, you need to list the most expensive procedure first. You are coding correctly in the example you have given. 31628 has a nonfacility RVU of 7.33, 31623 has an RVU of 5.99, and 31629 has an RVU of 4.82. The RVUs show that you are placing the highest-valued procedure first in order to receive maximal reimbursement.
Pulmonology Coding Alert
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