Pulmonology Coding Alert

Question: Our pulmonologist recently performed a resection procedure for an endobronchial tumor using electrocautery. He also had to undertake about an hour of critical care in addition to a basic cell washing procedure during the bronchoscopy. Please let me know if the cell washing can be reported along with the resection and the other codes that I need to report for the procedures conducted?

New Mexico Subscriber

Answer: Generally, a diagnostic bronchoscopy with a cell washing procedure is reported using 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]). This is a basic procedure that your pulmonologist will conduct in order to visualize the internal areas such as the vocal cords, the tracheobronchial tree, major lobar and the segmental bronchii. This procedure will help in establishing the presence of abnormalities in these areas and help him know if there is any necessity for any other procedure to be performed.

In addition to the primary procedure, your pulmonologist performed a resection of an endobronchial tumor using electrocautery. Since this procedure was performed, the diagnostic bronchoscopy with the cell washing procedure becomes a part of the resection procedure and should not be reported separately. Instead, you will only need to report the resection procedure and the diagnostic bronchoscopy becomes bundled into this procedure. So, you will only need to report the procedure with 31641 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with destruction of tumor or relief of stenosis by any method other than excision [e.g., laser therapy, cryotherapy]).

The critical care that your pulmonologist performed initially, prior to the bronchoscopy procedure and the resection procedure, can be reported using 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) as long as it meets the guidelines for critical care reporting, and it is clear that the procedure time is not be included in the critical care time.