Pulmonology Coding Alert

Question: Can a bronchoscopy with washings, brushings and alveolar lavage and biopsy be billed using 31622-31625? If not, which code or codes should be used when all four procedures are performed?

Colorado Subscriber  
Answer: Insurance carriers pay for bronchoscopic codes several ways, but that does not prevent you from coding correctly. Medicare has standard operating procedures for all bronchoscopy scenarios. Medicare allows you to report and be reimbursed for multiple bronchoscopic procedures using 31622 (bronchoscopy [rigid or flexible]; diagnostic, with or without cell washing [separate procedure]).
 
You report the scenario above beginning with the highest-valued procedure: 31625 (... with biopsy), 31624-51 (... with bronchial alveolar lavage; -multiple procedures), 31623-51 (... with brushing or protected brushings), 31645 (bronchoscopy; with therapeutic aspiration of tracheobronchial tree, initial [e.g., drainage of lung abscess]) and 31646 (... subsequent).
 
The washings are incorporated into the base (diagnostic) bronchoscopy code, which is not separately billable. Payment for the washings is included in the payment for the primary procedure, 31625. Other insurance carriers may pay you for only one procedure, depending on the individual contract. Usually, only the highest-valued procedure will be reimbursed. Keep track of your charges and denials for better reimbursement of multiple procedures when it comes time to renegotiate your contract.