These modifier tips tell you how to ratchet up reimbursement. Disentangle Fees for Multiple Bronchoscopies What you need to know: Payers deduct the base rate from each bronchoscopy code reported after the first because the base bronchoscopy value is included in the payment for the highest-valued procedure. And since the base payment is "built in" to all bronchoscopy codes, you can't expect payment for the initial diagnostic portion more than once. Therefore, you have to subtract the dollar amount for the diagnostic portion from the value of the remaining procedures performed that day. Example: Since the transbronchial lung biopsy is the most complex, you should code it first, followed by the less complex codes, according to the ATS example. You can report all three codes As far as payment, expect full reimbursement for the most complex procedure (31628) and reimbursement on the subsequent codes at a lower amount, which amounts to the difference between the code and the base bronchoscopy code. The formula would look like this: 31628 + [31624-31622] +[31623-31622] = net relative value units. Use the Base Code If the Circumstance Permits There always seems to be exceptions to hard and fast rules. Let's look at a scenario which would call for the use of the base diagnostic code 31622. You be the coder: The pulmonologist would code for the bronchial biopsy (31625) or other procedures and not 31622. If the pulmonologist didn't visualize a lesion, she would finish the bronchoscopy without any intervention and would only bill 31622, explains Example: A patient coughs up blood (hemoptysis). The pulmonologist bronchoscopes the patient to find the source of the bleeding and washes the areas where there is bleeding, but is unable to locate a specific bleeding source. The physician finishes the procedure. Report 31622 with 786.3 (Hemoptysis, cough with hemorrhage). Solving the 51-59 Modifier Conundrum is Easy Achieve optimum reimbursement for multiple bronchoscopies by knowing the scenarios that can put modifiers into play. As was stated above, reimbursement for bronchoscopies depends on the Multiple Endoscopy Rule. Modifier 51 does not apply to payments for bronchoscopies because the Multiple Procedure Rule (payment for the first procedure is 100 percent, payment for up to four other procedures is 50 percent for each) is not in force, says Plummer. Physician payment for bronchoscopies would be much higher under the Multiple Procedure Rule. Thus coders can ignore modifier 51 use for bronchoscopy coding. There are only two instances during which a 59 modifier should be used, Plummer continues. The National Correct Coding Initiative (NCCI) prohibits the reporting of a bronchial biopsy (31625) with either a transbronchial biopsy (31628) or a transbronchial needle aspiration (31629). The pulmonologist may override this edit by attaching a 59 modifier to 31625, but only when the bronchial biopsy is performed in a site different than the transbronchial lung biopsy or the transbronchial needle aspiration. Example: Good catch: If you think that you should consider that the bronchial biopsy and the transbronchial lung biopsy were performed in different areas, you are absolutely right! The bronchial biopsy took place in the right upper lobe and the transbronchial lung biopsy was in the left upper lobe. Because the sites are different for the bronchial and the transbronchial lung biopsies, NCCI allows unbundling with the 59 modifier. If the bronchial biopsy had occurred in the left upper lobe bronchus, you would have not been able to bill for it.