Pulmonology Coding Alert

Question: My physician is performing bronchial alveolar lavage (BAL) and biopsy through the established tracheostomy. The bronchoscopy report states they are done via nares or oral cavity -- no mention of tracheostomy. How should I code it? Can I use the traditional 31624-31625?

Idaho Subscriber

Answer: There is no specific code which describes a bronchial biopsy and BAL when the bronchoscope is inserted through a tracheostomy. You should code for the biopsy and BAL as if the bronchoscope was inserted through the mouth or nares, that is, by using 31625 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy[s], single or multiple sites) or 31624 (Bronchoscopy (rigid or flexible); with bronchial alveolar lavage), but if the physician is unable to visualize all the necessary structures (e.g., pharynx, larynx, trachea, etc) during any bronchoscopy procedure, append modifier 52 to indicate the reduced procedural service.

Warning: Do not use 31622 (Bronchoscopy (rigid or flexible); diagnostic, with or without cell washing [separate procedure]) as it is bundled into both 31625 and 31624.

Common ICD-9-CM codes would be atelectasis (518.0), hemoptysis (786.3) or lung cancer (162.x). You can read about all the bronchoscopy procedures in Chapter 9 of the ACCP Coding for Chest Medicine book.