Pulmonology Coding Alert

Question: A patient presents to the pulmonologist for possible lung cancer. The pulmonologist used electromagnetic navigation bronchoscopy (ENB) to help diagnose the lung cancer. What code should I submit for the test?

New Jersey Subscriber

Answer: For ENB reimbursements, you may submit a new code for 2010, CPT code 31627 (Bronchoscopy, with computer-assisted, image-guided navigation). While the code allows physicians to be reimbursed for performing ENB, make sure you list 31627 separately in addition to a primary bronchoscopy code since 31627 is a ZZZ, add-on, code which requires the listing of another primary bronchoscopy code when used. "ZZZ" represents add-on codes. These codes are related to another service and are always included in the global period of the primary service.

What goes on: ENB is a two step process. Initially the pulmonologist synchronizes the patient's chest CT with a specialized computer program to allow for a virtual bronchoscopy. The pathway to the lung lesion is mapped onto the program. The pulmonologist usually does it well before the bronchoscopy procedure. During the bronchoscopy, the patient lies on a table which allows for an electromagnetic field to be established. The bronchoscopy happens by utilizing the previously mapped computer image to guide the bronchoscope to the site of the lesion. Then, the pulmonologist inserts a special navigational catheter into the bronchoscope and maneuvers into the lesion or near the lesion. He then inserts a biopsy forceps or a transbronchoscopic needle into the lesion to  biopsy the lesion. You would code 31628 (... with transbronchial lung biopsy[s], single lobe) or 31629 (Bronchoscopy, rigid or flexible, with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus) for the biopsy and 31627 for the ENB.