Pulmonology Coding Alert

Question: Can you please tell me the exact sequence and modifier (if necessary) as to how I would bill for the following:

• 99232 (25) visit
• EBUS ?
• TBNA ?

I did billed it previously and the reimbursement for EBUS from Medicare was only $51.76 and my doctor told me that something is not right with the way I billed it (I used 31620 for the EBUS code).

Michigan Subscriber

Answer: You are right in using +31620 (Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention[s] [List separately in addition to code for primary procedure(s)]) as the CPT^® code to report the endobronchial ultrasound (EBUS) procedure that your pulmonologist performed. However, you will need to note that this is an add-on code that you will have to report with other bronchoscopy procedures (31622-31646) and cannot be reported as a standalone procedure. So, in your case scenario, you can capture this add-on code with the transbronchial needle aspiration biopsy procedure that your pulmonologist performed. You’ll report this procedure with the CPT^® code 31629 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]).

Since +31620 should be reported as an add-on code to 31629, you’ll have to report the two codes using the same invoice for billing. As you’re also claiming for the subsequent care service using 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient…) in the same session, you are correct in appending the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code.

So, you should report the procedures in the following sequence on the claim form:

• 31629 to bill out the TBNA
• +31620 to report the EBUS
• 99232-25 to claim for the E/M service

Note:When this service is performed in a facility—based setting (inpatient or outpatient hospital), the National Medicare reimbursement for +31620 is $68.05 with a facility work RVU of 1.40 and the 2013 conversion factor of 34.023, and without the geographical adjustment. As you were paid out only $51.76, your clinician is right in that you have not received the appropriate payment for the procedure. Please check with your Medicare contractor for the appropriate rate and co-pay/co-insurance responsibility for the beneficiary.