Pulmonology Coding Alert

Question: The provider performs bronchoscopy, uses a flexible bronchoscope to view and take biopsy samples from the left lower and middle lobes, under fluoroscopic guidance. Which code would be appropriate here?

Texas Subscriber

Answer: For biopsy on a single site or multiple sites, you might think of CPT® code 31625 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy[s], single or multiple sites). But in the scenario you describe, because the provider specifically mentions the lobar bronchi, you may be eligible to use more specific codes such as 31628 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe) along with an add-on code +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]) if the provider clearly identifies the transbronchial biopsy method.

Remember: Report 31628 only once and 31632 once per lobe, regardless of how many transbronchial lung biopsies the provider performed in a lobe.

If the provider performed transbronchial needle aspiration biopsy instead, you would report 31629 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) along with the add-on code +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]). Report 31629 only once. Report +31633 only once per lobe for upper airway biopsies, regardless of how many transbronchial needle aspiration biopsies are performed in the upper airway or in a lobe.