Pulmonology Coding Alert

Question: If I used the bronchoscopy codes 31628, 31623, and 31624 together in a claim, would I get a denial?

Maryland Subscriber

Answer: No. Experts agree that it is possible for multiple procedures to occur during one bronchoscopy session. If a bronchoscopy session included a BAL (31624, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage), a protected brush sampling (31623, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings), and a transbronchial lung biopsy (31628, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy[s], single lobe) all during one session, then you should report all three procedures. Don't forget to list the most complex procedure first, followed by the less complex codes.

Warning: Don't expect to get your reimbursement based on the sum of the individual reimbursements for each code. The total reimbursement is the most complex bronchoscopic procedure and the sum of the differences in reimbursement between each of the less complex codes and the base bronchoscopy code (31622, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]).