Pulmonology Coding Alert

Question: How do I bill bronchoscopy with transbronchial needle aspiration of multiple sites? A patient had a right upper lobe mass, right panatracheal, hilar and subcaninal adenopathy. Bronchoscopy was performed with endobronchial biopsies of the right upper lobe and wang needle aspiration of the right hilar node. Is the right use a combination of bronchoscopy codes 31625 and 31629 with the -51 modifier?

Florida Subscriber

Answer: These two codes would only be used together if separate lesions we biopsied using different methods. In that case, use 31629 and 31625-59 to indicate the separate locations of the lesions. When you only use the transbronchial needle aspiration method, addition of modifier -22 for the multiple aspirations may be appropriate. Use of this modifier, however, requires that the documentation be sent with the claim, and that the documentation demonstrate a significant increase in work effort. Additional payment using this method is determined case-by-case and not guaranteed. If allowed, expect an additional reimbursement of 20-30 percent.

31625 bronchoscopy, (rigid or flexible);
with biopsy
31629 bronchoscopy, (rigid or flexible); with transbronchial needle aspiration biopsy
-51 multiple procedures
-22 unusual procedural service