Pulmonology Coding Alert

Question: Our pulmonologist saw a patient with unusually thick and large mucus plugs, so he had to make two bronchoscopic attempts during the session with increasingly larger bronchoscopes that finally resulted in a therapeutic bronchoscopy. Is there any way we can collect more than what’s allotted for 31646 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, subsequent, same hospital stay)?

Codify Subscriber

Answer: Because the pulmonologist was medically justified in making several attempts, which added an exceptional amount of time to the session, you can append modifier 22 (Increased procedural services) to 31646. You should include a statement in your documentation, for instance, “this bronchoscopy took an hour and 45 minutes longer than the typical repeat therapeutic bronchoscopy” with the corresponding details.

In such a case, you are justified to bill modifier 22 and request additional reimbursement for this case by increasing the charge; documentation and a cover letter will need to be provided to the payer to support the request for additional reimbursement. Here, the physician can demonstrate significant additional effort. That calls for additional compensation as well, and modifier 22 can get you that.