Pulmonology Coding Alert

Question: What code should I report for a bronchoscopy if the pulmonologist was scheduled to "assist" a surgeon while he does a percutaneous tracheostomy?

New Mexico Subscriber

Answer: You would often encounter a second pulmonologist "assisting" in a percutaneous tracheostomy (31600, Tracheostomy, planned [separate procedure]), which is a planned procedure and commonly performed by pulmonologists, as well as ENT physicians and some thoracic surgeons. The second pulmonologist "assists" by observing the tracheal site during the tracheostomy with a bronchoscope.

When coding in this scenario, consider the following:

• If the bronchoscopy also includes a medically necessary inspection of all the airways sometime during, before, or after the tracheostomy, then the pulmonologist handling the bronchoscope should bill for a  bronchoscopy (31622, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]). This billing should occur if the pulmonologist assists another pulmonologist, ENT physician, a thoracic surgeon, or any other physician.

• If the pulmonologist performs a percutaneous tracheostomy and allows another pulmonologist to perform the bronchoscopy under the direct supervision, the second pulmonologist can bill for a bronchoscopy, so long as inspection of the airways (complete bronchoscopy) also occurred during the tracheostomy. The first pulmonologist should bill for the percutaneous tracheostomy, 31600. Documentation should include the indication for the complete bronchoscopy.