Pulmonology Coding Alert

Question: Our pulmonologist recently performed a flexible bronchoscopy during which he performed transbronchial biopsy and endobronchial biopsy in right lower lobe. Since there are two separate codes, 31628 and 31625, can both be reported for this patient or should only one code be reported?

Illinois Subscriber

Answer: When your clinician performs an endobronchial biopsy, you report this procedure with the CPT® code 31625 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy[s], single or multiple sites). Report this code only once even though your clinician removed samples from multiple sites.

For transbronchial biopsy, you should report 31628 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe). Report one unit of the code even if your clinician removed samples from multiple sites within the lobe.

If you are trying to report 31625 with 31628 for the same patient on the same calendar date of service, you will face bundling according to Correct Coding Initiative (CCI) edits. According to these edits, 31625 is a component of 31628 and cannot be billed unless the site was separately identifiable from the transbronchial biopsy site, even within the same lobe. Your documentation would need to specify the exact location of the tissue sampled for each method.

So, you will need to provide documentation to prove that the sites in which your clinician performed the endobronchial and transbronchial biopsies were different. With this you can report both the codes together for the visit, but you will need to append modifier 59 (Distinct procedural service) to 31625 to allow payment for both of the codes.