Pulmonology Coding Alert

Question: A pulmonologist performs one trans-bronchial biopsy in the right-upper lobe, two biopsies in the left-upper lobe, and one in the left-lower lobe. Do I need to use modifier 51 on 31632?


Pennsylvania Subscriber

Answer: No. Code +31632 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy[s], each additional lobe [list separately in addition to code for primary procedure]) is an add-on code that represents additional transbronchial lung biopsies during bronchoscopy. Therefore, you don't need to use modifier 51 (Multiple procedures) on the code. Add-on codes are exempt from multiple procedure rules including the associated payment reduction. You do, however, need to follow these rules when using 31632:

Rule 1: You must always report add-on codes in addition to the base procedure. In this case, you must always use 31632 in conjunction with 31628 (... with transbronchial lung biopsy[s], single lobe).

Rule 2: You should assign 31632 only once per additional lobe that your pulmonologist treats, regardless of the number of transbronchial biopsies the physician performed within that lobe. So even though the physician in your example performs two biopsies in the left-upper lobe, you would code this with 31632 once for this location, not twice.

Rule 3: When the scenario involves biopsies in different lobes, you will code multiple units of 31632. For the above case, you will report 31632 once for the left-upper lobe procedures and once for the left-lower lobe biopsy. Complete coding for the above scenario is as follows:

• 31628 for the right-upper lobe biopsy

• 31632 with a "2" in the units' field for the left-upper lobe and left-lower biopsies.