Pulmonology Coding Alert

Question: Our physicians will soon begin performing navigational bronchoscopies. How should we code for these procedures?

New Mexico Subscriber

Answer: Electromagnetic navigational bronchoscopy allows physicians to access peripheral lung lesions. The system used to conduct the procedure received FDA approval in July 2007, but CPT does not have a code for it.

The system manufacturer recommends reporting 77299 (Unlisted procedure, therapeutic radiology clinical treatment planning) for the treatment planning stage and 31899 (Unlisted procedure, trachea, bronchi) for the navigational portion of the procedure. If your physician performs bronchial biopsies, transbronchial biopsies or transbronchial needle aspirations, code separately with 31625 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy[s], single or multiple sites), 31628 (... with transbronchial lung biopsy[s], single lobe) or 31629 (... with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]).

Many carriers, however, do not reimburse for electromagnetic navigational bronchoscopy. Document your physician's work and file the claim, but know that reimbursement is unlikely.

Potential bonus: The American Thoracic Society (ATS) and the American College of Chest Physicians (ACCP) have submitted navigational bronchoscopy coding proposals for consideration at the October 2008 CPT Editorial Panel meeting.