Pulmonology Coding Alert

Question: The report I have states the pulmonologist performed a diagnostic bronchoscopy using a flexible fiberoptic bronchoscope. The provider also collected a transbronchial lung biopsy and sent it off to pathology for further testing. We originally assigned 31622 and 31628 to report the procedures, but the claim was denied.

How do we correct this claim?

New York Subscriber

Answer: You can correct this claim by assigning only 31628 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe). This code covers the flexible bronchoscopy with the transbronchial lung biopsy.

Using 31622 (… diagnostic, with cell washing, when performed (separate procedure)) to report the diagnostic flexible bronchoscopy and then 31628 to report the transbronchial biopsy is tempting, but ultimately incorrect. That’s because 31622 is bundled into 31628, according to the National Correct Coding Initiative (NCCI) procedure-to-procedure edits.

Code 31622 carries a modifier indicator of “0” as a column 2 code for 31628, which means the two codes can never be unbundled and reported separately. Payment for the diagnostic procedure is included in the payment for the “surgical/ interventional” bronchoscopy.