Pulmonology Coding Alert

Question: Can we bill critical care and bronchoscopy on the same day? Is a modifier required?

Pennsylvania Subscriber

Answer: According to current Medicare edits, CPT 31628 (bronchoscopy, [rigid or flexible]; with transbronchial lung biopsy, with or without fluoroscopic guidance) and 31629 (bronchoscopy, [rigid or flexible]; with transbronchial needle aspiration biopsy) are not bundled into critical care. You can bill both, but carriers may vary on accepting this. You can bill critical care on any day, no matter what other services are performed, so long as the criteria for 99291 (critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) are met, and the time is documented.

Because 99291 and 99292 (critical care each additional 30 minutes) are evaluation and management codes, you may need to provide modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the critical care code. In addition, most carriers will not allow you to include the time spent performing the bronchoscopy in the time for critical care.