Pulmonology Coding Alert

Question: A patient presented to our pulmonology practice with thick and unusually large mucus plugs. The pulmonologist wrote in their report that they had to attempt two bronchoscopies during the visit, with the 2nd bronchoscopy longer than the first. This additional attempt resulted in a therapeutic bronchoscopy.

Aside from reporting CPT^® code 31645, is there anything else I should do so the practice receives proper reimbursement?

Idaho Subscriber

Answer: The patient’s abnormal mucus plugs provided medical necessity to warrant the provider’s repeated bronchoscopy attempts. Due to the multiple attempts, you can append modifier 22 (Increased procedural services) to 31645 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial). The modifier allows your practice to request additional payment for the additional time required to perform the complete the procedure, but you will have to increase your standard charge in order for the payer to consider the additional payment.

Depending on the payer’s preferences, you may need to provide documentation and a cover letter justifying the request for increased reimbursement. In the documentation, your physician can illustrate the significant additional effort needed for the session with tangible evidence by including the comparative time between a typical procedure and this extended procedure.