Pulmonology Coding Alert

Question: Our pulmonologist performed bronchioloalveolar biopsy of the left upper lobe in the anterior subsegment and also in the left upper lobe in the posterior subsegment. He wants us to code this with two units of 31624 but I think it should be 31624-50. Who is right?

Codify Subscriber

Answer: Unfortunately, both of your coding scenarios are inaccurate, since 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) covers only alveolar lavage and not biopsy.

Instead, biopsy of the bronchioalveolar region would occur via needle aspiration (31629).

You don’t need to report multiple units of the code or append modifier 50 (Bilateral procedure) because the descriptor specifically includes single or multiple aspiration biopsies from the trachea, main stem, or a single lobe. Therefore, reporting the single unit of 31629 will cover the two biopsies to the left lobe.

As an aside, if additional aspiration biopsies were performed in different lobes, you could also report 31633 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy[s], each additional lobe [List separately in addition to code for primary procedure]) once per additional lobe. This is reported in addition to 31629.