Pulmonology Coding Alert

Question: The pulmonologist performs a level-four E/M for a new patient, then provides a flexible diagnostic bronchoscopy with cell washing. Based on the diagnostic results, the pulmonologist orders the patient back a week later for a bronchoscopy with brushing. Can I report both bronchoscopy codes, or should I just choose one?

Wyoming Subscriber

Answer: Because the bronchoscopies occurred at different sessions on different dates, you would report them separately.

Just make sure the documentation includes the reason for the separate sessions, or you may be denied for frequency issues. On the claim for the first encounter, report the following:

• 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]) for the diagnostic bronchoscopy

• 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; medical decision- making of moderate complexity) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to 99204 to show that the E/M and bronchoscopy were separate services.

Remember: Clearly indicate the date of the first bronchoscopy and E/M on the claim.

When coding for the second encounter, report 31623 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with brushing or protected brushings). Also be sure to note the date the pulmonologist performs the second bronchoscopy.

CCI warning: You cannot report two procedure codes if the physician performs both bronchoscopies on the same date, even if the physician conducts them during separate sessions with the patient. In these scenarios, the Correct Coding Initiative (CCI) bundles the diagnostic bronchoscopy (31622) into other bronchoscopies, without the ability to unbundle the services.