Pulmonology Coding Alert
Bill 31628 If Biopsies Occurs In The Same Lobe
Question: Op note says: The pulmonologist introduced the scope through the right nostril and advanced to the vocal cords and into the trachea. The tracheal rings appeared normal. The physician, then, withdrew the scope to the upper lobe and lower lobe subsegments. No endobronchial lesions were noted. The scope was withdrawn and advanced to the right upper lobe and right middle and lower lobe subsegments. No endobronchial lesions noted. Then, under fluoroscopic guidance, the scope was wedged in the right upper lobe and posterior subsegment, and the area corresponding to the lung nodule was noted on fluoroscopy, and transbronchial biopsy was performed four times under fluoro guidance. Again, under fluoro guidance, the physician performed cytology brushing twice, and bronchoalveolar lavage (BAL) on the same area (sent for path and cyto and culture and sensitivity). We billed 31623, 31624 and 31628, 31632x3 but the payer denied 31632x3. What did we do wrong? What do we report? Illinois Subscriber Answer: Be sure to report 31623 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings) for the brushings. You would report this code only once regardless of how many samples were obtained. You would code the BAL with 31624 (...with bronchial alveolar lavage), while you could capture the transbronchial biopsy with 31628 (...with transbronchial lung biopsy[s], single lobe). Despite having biopsied four times, the physician should only report 31628 since all of the biopsies took place in the same lobe. Reserve code 31632 (...with transbronchial lung biopsy[s], each additional lobe [List separately in addition to code for primary procedure]) for transbronchial biopsies that occur in each lobe that is different from the primary lobe biopsied.
Pulmonology Coding Alert
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