Pulmonology Coding Alert

Question: Can we bill together 31628, 31629 and 31625 for the same LLL?

Mississippi Subscriber

Answer: You may use 31625 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy[s], single or multiple sites) when the provider performs rigid or flexible bronchoscopy to obtain bronchial or endobronchial biopsies from single or multiple sites. She may or may not use fluoroscopic guidance to perform this test.

The code 31628 represents “Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe.” As per the notes, 31628 should be reported only once regardless of how many transbronchial lung biopsies are performed in a single lobe. Use +31632 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], each additional lobe [List separately in addition to code for primary procedure]) in addition to 31628 when the provider obtains a transbronchial biopsy from each different lobe of the lung using bronchoscopy. He may or may not use fluoroscopic guidance to perform this test.

The code 31629 comprises “Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i).” You may report 31629 only once for upper airway biopsies regardless of how many transbronchial needle aspiration biopsies are performed in the upper airway or in a single lobe.

Use 31233 when the provider performs rigid or flexible bronchoscopy to obtain a transbronchial needle aspiration biopsy in a different lobe. She may or may not use fluoroscopic guidance to perform this test.

As per CCI edits, you may report all the three CPT^® codes along with modifier 59 (XEPSU) to 31625 but do make sure that documentation of medical record supports usage of this modifier. Documentation must support different procedure, session or surgery, site or organ system, separate lesion, incision/excision, or injury.