Pulmonology Coding Alert

Reviewed on May 15, 2015 Bronchoscopy is a common procedure. Codes (31622-31656) describe the various methods, often performed in one session. Reimbursement for multiple bronchoscopies can be achieved by knowing what to code separately and which modifiers to use. Use modifier -59 (Distinct procedural service) when separate biopsies are performed on different sites or lesions during the same bronchoscopy. Report modifier -51 (Multiple procedures) to indicate multiple procedures performed at the same setting. The base code, 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]), is used for the diagnostic portion. The procedure is first performed to examine the inside of the patient’s lungs. If a problem such as a lesion is located, the physician may continue the procedure by performing a surgical intervention: biopsy, needle aspiration, removal or excision, brushing, or alveolar lavage. Because the diagnostic part is inherent to the surgical portion, 31622 is bundled into the other bronchoscopy codes,” says Walter O’Donohue, MD, FCCP, FACP, founder of the CPT® committee of the American College of Chest Physicians (ACCP) and a representative to the AMA CPT® advisory committee for ACCP. “Pulmonologists can only bill 31622 separately if the bronchoscopy is stopped after looking inside the patient’s lungs or when they only perform bronchial washings.”    Example: A patient is coughing up blood (hemoptysis). The pulmonologist uses a bronchoscope to find the source of the bleeding and to wash areas where there is bleeding but is unable to locate a problem. The physician stops the procedure. Report 31622 with a diagnosis of 786.3 (Hemoptysis) Under ICD-10, the equivalent diagnosis code will be R04.2, Hemoptysis. Code Multiple Bronchoscopies Separately with Modifier -59 The main challenge in bronchoscopy coding comes when multiple procedures are performed. Although they may occur during the same session biopsies on different lesions and/or anatomic sites are separate and can be coded as such. When the Correct Coding Initiative (CCI) bundles these procedures appending modifier 59 indicates that two separate biopsies were performed on different sites or lesions during the same bronchoscopy (with the exception of the bronchial biopsy [31625], which can be billed only once). Under the new rule introduced in 2015, you may have to use one of the new X{EPSU} modifiers and modifier 59 will be considered a modifier of last resort. Check payer preferences. “Past CCI edits did not allow a bronchial biopsy (31625) to be coded with a transbronchial biopsy (31628) or a needle aspiration biopsy (31629) even though they are different procedures,” O’Donohue says. The bronchial biopsy is performed with biopsy forceps directed at visible bronchial tissue or a visible endobronchial lesion. The transbronchial lung biopsy is performed peripherally (where the doctor [...]