Pulmonology Coding Alert

Question: Recently our pulmonologist performed a bronchoscopy with left-upper lobe and left-lower lobe endobronchial biopsies, left-lower lobe transbronchial biopsy, left-upper lobe brushing, left-upper lobe washing and left-lower lobe washing. How should I code this code this encounter?

Idaho Subscriber

Answer: The correct code for bronchoscopy with left-upper lobe and left-lower lobe endobronchial biopsies is 31625 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy[s], single or multiple sites). You will code 31625 only once even for multiple sites.

For the left lower lobe transbronchial biopsy you should report 31628 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe) since only one biopsy was performed. Code 31628 can be billed only once even for multiple bronchial sites in a single lobe. If the bronchoscopy with biopsies was performed in the left lung, upper and lower lobes, it is inappropriate to use 31628 twice (i.e., once for the left-upper lobe and once for the left-lower lobe). Additional transbronchial lung biopsies in additional lobes would be reported with additional code +31632 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], each additional lobe [List separately in addition to code for primary procedure]).  Therefore, transbronchial biopsies in the left upper and left lower lobes would be reported as 31628, 31632.

However, according to the national Correct Coding Initiative, 31625 is a component of 31628 and cannot be billed unless the site was separately identifiable from the transbronchial biopsy site, even within the same lobe. Your documentation would need to specify the exact location of the tissue sampled for each method. Code 31628 would be billed as the primary procedure because it has the highest relative value unit (RVU). The transitional nonfacility total RVU for 31628 is 10.60. If the documentation supports a separate endobronchial biopsy site, then you would also report 31625-59.

Your question indicated the physician performed a left-upper lobe brushing. The correct CPT^® code for this procedure is 31623 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings). Although a separate procedure, washings are a standard part of a bronchoscopy (i.e., 31622, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]). Therefore, you should not report them when other bronchoscopy services are provided during the same session.