Pulmonology Coding Alert

Question: Our pulmonologist recently performed a therapeutic aspiration along with lavage on a patient suffering from severe bleeding in the left lower lobe. He also injected epinephrine to bring the bleeding under control. Can you please tell me how I need to code the procedures that our pulmonologist performed?

Massachusetts Subscriber

Answer: For the therapeutic aspiration that your pulmonologist performed, you will need to report it with 31645 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial [e.g., drainage of lung abscess]).

To confirm whether or not your pulmonologist performed a bronchial alveolar lavage (BAL) or a cell washing, you will have to look deeper into the documentation. You can identify if your pulmonologist performed a BAL by amount of saline that your pulmonologist used during the procedure. It will usually be about 100cc (with manual suctioning) that is instilled in five fractions of 20cc while washing is done with about a total of 5-15cc with suctioning.

If you are still not sure if your pulmonologist conducted a lavage or a cell washing, you can check with your pulmonologist to be double sure. If he performed a bronchoalveolar lavage, you can report it with 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage). There is no Correct Coding Initiative (CCI) edits to report 31645 and 31624 and these two procedures can be reported together in the same session.

Instead, if he only performed a cell washing, it is included in the base procedure (31622). You cannot separately report 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]) as this code is a column 2 code for 31645 with the modifier '0' that indicates that these two codes cannot be reported together under any circumstances.

Note that there is no separate code to report the use of epinephrine to bring the bleeding under control. If your pulmonologist spent significantly more time than usual (more than 30 percent time in comparison to the usual time), you can mull over using modifier 22 (Increased procedural services) to the codes you are reporting. But ensure that you have proper documentation to show that your pulmonologist spent this extra time or else you might face denials to your claims.