Pulmonology Coding Alert

Question: When a physician performs a broncho-scopy with biopsies of both the left upper lobe and the left lower lobe, is it appropriate to bill the biopsy code twice (with modifier -59 [Distinct procedural service] on the second code), or does the code include both lobes?


New Hampshire Subscriber

Answer: When a physician performs the biopsies during bronchoscopy, you should choose the most appropriate code based on the method the physician used.

The physician may perform a bronchial or endobronchial biopsy in multiple sites. In this case, you can only report 31625 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy[s], single or multiple sites) once. If the physician performs transbronchial lung biopsies (31628, ... with transbronchial lung biopsy[s], single lobe) and transbronchial needle aspiration biopsies (31629, ... with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]), you can report them separately when the physician performs them on different lesions, even if on the same lobe.

If the surgeon performs a transbronchial lung biopsy in the right upper lobe and right lower lobe, report 31628 for the first biopsy and +31632 (... with transbronchial lung biopsy[s], each additional lobe [list separately in addition to code for primary procedure]) for the biopsy in the second lobe.

Similarly, if the physician performs a transbronchial needle aspiration in the left upper lobe and left lower lobe, you should report 31629 for the first biopsy and +31633 (... with transbronchial needle aspiration biopsy[s], each additional lobe [list separately in addition to code for primary procedure]) for the biopsy in the second lobe. When you report either a transbronchial lung biopsy or a transbronchial needle aspiration biopsy, you should report multiple biopsies, of each type, in the same lobe only once.