Pulmonology Coding Alert

Question: One of my physicians is telling me to use 31646 only for repeat aspiration on the same date as an initial clear airway 31645 was performed. His understanding is that is the only time you would report 31646.

It was my understanding that if multiple physicians are rounding on a patient that requires daily aspirations due to pneumonia or other issue would be to report the first date as 31645 for the initial clear airway and the second date would be the subsequent code of 31646. Tell me who is correct.

Illinois Subscriber

Answer: Both of you are correct and wrong to a certain extent. As per the descriptors, the CPT® code 31645 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial [e.g., drainage of lung abscess]) is used when your pulmonologist tries to clear the airways in an initial attempt and 31646 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, subsequent) for a subsequent attempt during the same episode of care (i.e., hospitalization).

However, as per the Correct Coding Initiative (CCI) edits, 31645 is a column 2 code for 31646 and it cannot be reported separately on the same day unless a suitable modifier is appended to 31645 to separate the two services.

As per the guidelines for the CCI edit, you cannot report 31645 and 31646 together for attempts by your pulmonologist to clear the airways during a single session. However, if your pulmonologist attempts to clear the airways during multiple sessions on a single day, you can report the services with 31645 and 31646. But as CCI edits are in place, you will have to use the modifier 59 (Distinct procedural service) to 31645 to help the payer distinguish the services performed and enable reimbursement for both the codes.

If your pulmonologist is attempting an initial clearing of the airway on one day and again attempting clearing of the airway on day two, then you can report 31645 for day one and 31646 for attempt to clear the airway on the second day. But if your pulmonologist attempts to clear the airways on multiple sessions during the second day, you still have to use only one unit of 31646 to report the services provided for that day.