Pulmonology Coding Alert

Question: I’m stumped as to how to code this report. The patient presented for a therapeutic aspiration to remove a partially obstructing blood clot in the left secondary bronchus via bronchoscopy. The procedure was performed successfully.

What codes do I report for this encounter?

Montana Subscriber

Answer: This is a tricky one! For the procedure, you’ll assign 31645 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial). Of the bronchoscopy codes listed in the AMA CPT^® code set, there isn’t a code that specifically calls out blood clot removal. The “therapeutic aspiration of tracheobronchial tree” listed in 31645’s descriptor is sufficient to represent the physician’s procedure.

As far as the partially obstructing blood clot in the left secondary bronchus, you’re best to assign J98.09 (Other diseases of bronchus, not elsewhere classified).

Some coders may consider assigning a pulmonary embolism code, such as I26.99 (Other pulmonary embolism without acute cor pulmonale), which includes an additional term of acute pulmonary embolism NOS. However, choosing a pulmonary embolism diagnosis code would be incorrect since the clot involved a portion of the bronchial tree, not a pulmonary vessel.