Pulmonology Coding Alert

Question: Our doctor has just started doing bronchoscopy with EBUS. I want to make sure I am coding the procedures correctly.

Operative Report: lymph nodes of station 2R, 7, and 10R were identified. Transbronchial needle aspirate with EBUS was collected from each. Conventional scope was reintroduced and brush samplings and forceps biopsies were collected.

I coded this 31629, 31620, 31633 x 2, 31623, and 31625. Is this correct?

South Florida Subscriber

Answer: You are correct in choosing the codes for the procedures that your pulmonologist performed in the session. So here is a list of the codes that you will have to report:

• 31629 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus[i]
• +31620 -- Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) (list separately in addition to code for primary procedure[s])
• 31623 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings
• +31633 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy[s], each additional lobe [list separately in addition to code for primary procedure]
• 31625 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites. Append modifier 59 (Distinct procedural service) to 31625.

Note that you should not use 31633 x 2 but report only one unit of 31633. 31633 is an add-on code and should be reported only once per additional lobe irrespective of the number of transbronchial needle aspiration biopsies that your pulmonologist performs in the additional lobe. In order to report 2 units of 31633, lymph node sampling would have to occur in a third lobe. Only two areas were noted in the report: stations 2R & 7 are the right upper paratracheal nodes and subcarinal nodes, repectively. These are considered part of the trachea/mainstem area. Station 10R represents the right hilar nodes which are proximal lobar nodes.

Also, 31625 is a column 2 code for 31629. This means that you cannot report the two codes for the same session unless you append the modifier 59 to 31625. This will help the payer distinguish the two procedures as separate enabling appropriate reimbursement for both the procedures.