Pulmonology Coding Alert

Question: One of our physicians wants to report 31623, 31625 and 31629 for the same bronchoscopic session during which the physician introduced a fiberoptic bronchoscope orally.

The vocal cords appeared and adducted normally. The trachea and main carina, right and left endobronchial tree appeared normal and patent to the level of the subsegmental bronchi except for the presence of an endobronchial tumor mass, which appeared somewhat necrotic in the superior division of the lingular segment of the left upper lobe.

The physician obtained a transbronchial needle aspiration from the mass as well as bronchial brushing and bronchial biopsy. Preliminary cytology report suggests carcinoma, probable small cell with a final report pending. There was only mild bleeding, which was readily controlled with some topical epinephrine. Should I report all of the codes together?


Missouri Subscriber

Answer: For bronchoscopic services, you can report multiple codes per session if the report clearly reflects the services the physician provided. 

Remember: You must also consider the National Correct Coding Initiative (NCCI) edits, which bundle certain services together.

In this case, the physician performed each of the codes listed above. NCCI prevents you from reporting 31625 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy[s], single or multiple sites) and 31629 (... with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) together when the physician performs the biopsies on the same lesion/mass. 

If the physician performs the biopsies in different areas, and the report clearly identifies this, you should report the two codes together (31625 and 31629) by appending modifier -59 (Distinct procedural service) to 31625. 

Since the report, in this case, identifies that the physician used two biopsy methods for the same site, you should only report 31629 with 31623 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with brushing or protected brushings). 

Some insurers do not require the use of modifier -51 (Multiple procedures) with the second bronchoscopy code you report because bronchoscopy services are paid according to the endoscopy payment rules, not the multiple procedure rules.