Pulmonology Coding Alert

Question: My coding problem involves a 3-hour surgical session for bronchoscopically monitored aortopexy and pulmonary artery-pexy for a 5-year-old patient. A cardiothoracic surgeon performed the aortopexy and pulmonary artery-pexy. Our pulmonologist performed a bronchoscopy before, during and after the surgical procedures to monitor the patient's condition and the effectiveness of the surgery. Our pulmonologist was present for the entire 3-hour period. How should our pulmonologist's services be coded?

Dallas Subscriber

Answer: Concurrent intraoperative bronchoscopic monitoring is mandatory in the anterior aortopexy of tracheomalacia to find the correct site of extrinsic vascular compression responsible for narrowing of tracheal lumen in tracheomalacia.

Since there is no specific code for the bronchoscopy services that your pulmonologist provided to monitor the aortopexy and pulmonary artery-pexy services that the cardiothoracic surgeon provided, you can attempt to separately report the service using the unlisted code 31899 (Unlisted procedure, trachea, bronchi).

Ensure that you provide adequate documentation about the services provided by your pulmonologist to prevent the claim being rejected for the unlisted code. Remember that you need to associate a code/service description and fee on the claim form. The payer may consider this service "navigational" and inclusive to the primary procedure, for which separate payment will not be made.

Alternatively, you may also elect to report the service as an assistant surgeon, if appropriate. Assistant-at-surgery services provided by a physician must be reported using the same surgical procedure code(s) reported by the primary surgeon, appended with modifier 80 (Assistant surgeon). Each physician must personally document their portion of the surgery. Your pulmonologist will receive 16 percent of the allowable reimbursement.