Pulmonology Coding Alert

Question: A patient undergoes a routine bronchoscopy. When the pulmonologist discovers a vascular abnormality, she performs an endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) on the patient at the same time. Can I bill for both EBUS and TBNA procedures?

Montana Subscriber

Answer: Yes. If you refer to your CPT book, you'll see that the EBUS code 31620 (Endobronchial ultrasound [EBUS] duringbronchoscopic diagnostic or therapeutic intervention[s] [List separately in addition to code for primary procedure[s]]) can be used with all bronchoscopy codes from 31622-31646.

Example: If the pulmonologist used EBUS to perform transbronchial needle aspirations of lymph nodes located on the right and left sides of the trachea, and sampled lymph nodes in the right hilar areas, you should code 31629 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) once for the transbronchial needle aspirations of the lymph nodes from both tracheal sites, the add-on code 31633 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial needle aspiration biopsy[s], each additional lobe [List separately in addition to code for primary procedure]) for the trans-bronchial needle aspirations from the right hilum, and 31620 for the EBUS.

Important: EBUS is an add-on code which must always appear on the same invoice as its primary procedure code (31622- 31646). Do not list add-on codes alone on the claim form.