Pulmonology Coding Alert

Question: An established 64-year-old patient reports to the pulmonologist for a scheduled flexible bronch-oscopy. The pulmonologist performs the procedure, taking transbronchial lung biopsies from two lobes. Due to the patient's anxiety and pain, the pulmonologist provides 26 minutes of moderate sedation during the procedure. Can we report the sedation separately?

Massachusetts Subscriber

Answer: You cannot report the moderate sedation separately in this instance. Moderate sedation is bundled into many of the bronchoscopy codes, so you cannot report 99144 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time).

How can I tell? It's easy to check if moderate sedation is bundled into a procedure code -- simply look up the code in the CPT book. If the code has the target sign 8 next to it, you cannot report moderate sedation in addition to that code. The code for bronchoscopy with lung biopsy, 31628, has such a mark next to it. (All codes that include moderate [conscious] sedation are listed in Appendix G of your CPT book.)

You should report the following:

• 31628 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy[s], single lobe) for the bronchoscopy with transbronchial lung biopsies of the first lobe.

• +31632 (... with transbronchial lung biopsy[s], each additional lobe [list separately in addition to code for primary procedure]) for the transbronchial lung biopsies of the second lobe.