Pulmonology Coding Alert

Question: A physician in our practice wants to bill for conscious sedation when he performs bronchoscopy. I told him that according to the Medicare NCCI guidelines, he can't bill conscious sedation when he performs bronchoscopy at the same session. He now wants to know whether commercial carriers will allow him to bill for the conscious sedation that he performs with bronchoscopy. How should I address the issue with my physician?

Kentucky Subscriber
 
Answer: Your advice is correct because the National Correct Coding Initiative guidelines do restrict practices from reporting conscious sedation (99141-99142) with any bronchoscopy codes (31615-31656, except 31630, 31631, 31640, and 31641, which require general anesthesia).

This rule applies only to Medicare guidelines, so it is possible that other private carriers may allow you to report both procedures when the physician performs them during the same session. As always, check your local carrier's guidelines before you report these codes, bundled or unbundled.