Pulmonology Coding Alert

Question: The physician performed a bronchoscopy through an established trach (patient is vent dependent). The findings were mucus plugs in left lung and small 3 mm endobrachial lesion at start of middle lobe bronchus, right lung. Will code 31615 cover this bronchoscopy with the biopsy and mucus plug suction? What about 31622, 31623 and 31624?

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Answer: Yes. You should report 31615 (Tracheobronchoscopy through established tracheostomy incision) for a flexible bronchoscopy via a tracheostomy. This code covers elements of both surgical work (removal of obstructing crusts) and diagnostic bronchoscopy when the same physician performs the procedures.

Caution: You should not report two codes for one procedure. CPT® code 31615 describes a diagnostic tracheobronchoscopy through an established tracheostomy site or incision. Once the procedure involves interventions, a standard bronchoscopy code should be used.31625 is used for endobronchial biopsy.You can only submit code 31623 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings) if the physician has documented protected brushings. All brushings (single or multiple lobes) are included in this code, so only report it once.

Code 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) is warranted only in cases where BAL (bronchial alveolar lavage) has been carried out during bronchoscopy.