Pulmonology Coding Alert

Question:

Oregon Subscriber

Multiple procedures are permissible, and can occur during one bronchoscopy session. For instance, bronchoscopy might include a BAL (31624, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage), a protected brush sampling (31623, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings), and a transbronchial lung biopsy (31628, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe), all during one session. In this case, you should report all three codes: 31628, 31623, 31624.

Tip: Always code the most complex code first, followed in order by the lower-complexity codes. However, the total reimbursement is not the sum of the individual reimbursements for each code. Rather, the total is the most complex bronchoscopic procedure, and the sum of the differences in reimbursement between each of the less complex codes and the base bronchoscopy code 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]).