Pulmonology Coding Alert

Question: My pulmonologist performed a diagnostic bronchoscopy and then discharged the patient on the same day. What discharge code should I use?


Oregon Subscriber
 

Answer: The code for the patient's discharge will depend on whether she was admitted to the hospital.

Option 1: If your pulmonologist performed the bronchoscopy as an outpatient procedure, you won't report a discharge code at all. In fact, you should not report a separate visit code at all, unless the physician provided a separately identifiable E/M service on the same date (e.g., medical management options for the mass biopsied during bronchoscopy).

Option 2: If the physician admitted the patient to observation, you should report the procedure code and the appropriate observation code (99218-99220, Initial observation care, per day, for the evaluation and management of a patient). Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the observation code to indicate that the service was separate from the bronchoscopy procedure.
 
For example, if the pulmonologist performed the bronchoscopy and then admitted the patient to observation for increased shortness of breath, you should report 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]) for the diagnostic bronchoscopy and 99218-25 for the observation service.

Option 3: If the patient was an inpatient at the hospital during the time of the bronchoscopic procedure, you should report the appropriate discharge code (99238-99239, Hospital discharge day management ...) to capture the service provided.

Discharge services are not part of bronchoscopy procedures and you can report them separately. Despite this, you'll still need to append modifier 25 to alert the payer that the service was separate from the bronchoscopy.