Pulmonology Coding Alert

Question: The patient is a 74-year-old man with a history of heavy smoking, with bilateral lung masses and weight loss. Following careful conscious sedation, the pulmonologist performs a bronchoscopy. The doctor initially attempted the procedure in the left nostril, but due to swelling mucosa, opted for the right. Vocal chord structure and function were normal. The tracheobronchial tree was normal on the right side, but the left side showed a mass obstructing the upper lobe. Under fluoroscopic guidance, the pulmonologist obtained biopsies of the left upper lobe mass and performed washings and brushings. Should I report one or two CPT codes? North Carolina Subscriber Answer: Two. Without any elaboration on the method your pulmonologist used to obtain the biopsies, you should report the biopsies with 31625 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy[s], single or multiple sites) and the brushings with 31623 (... with brushing or protected brushings). Obtaining washings is integral to the procedure's diagnostic portion. Codes 31625 and 31623 are exempt from modifier 51 (Multiple procedures). You do not need to use modifier 51 with this code combination unless a private payer requires the modifier for payment.