Pulmonology Coding Alert

Question: A pulmonologist performs a fiberoptic bronchoscope and notes: "The entire transbronchial tree was inspected to the subsegmental level, and brushings were done. Two separate Wang needle aspirations were done in different locations, several biopsies were done of the mucosa, and a couple of transbronchial lung biopsies were done, not stating any particular area for these."

Per the pathology results, all biopsies were done in the right lower lobe of the lung. Should I charge all of these procedures?

Florida Subscriber

Answer: Because documentation does not indicate separate lobes, you should code only the initial transbronchial lung biopsy, as well as these procedures:

• "couple of transbronchial lung biopsies": 31628 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy[s], single lobe).

• "several biopsies were done of the mucosa": 31625-51 (... with bronchial or endobronchial biopsy[s], single or multiple sites; Multiple procedures). Caution: Do not report this code unless documentation explicitly identifies the location of the biopsy, to differentiate it from the transbronchial lung biopsy sites.

• "brushings were done": 31623 (... with brushing or protected brushings).

Tip: Show your pulmonologist that he may be losing a lot of money by not documenting the details of what was done. Explain that noting "transbronchial lung biopsies" and "several biopsies" without indicating lobe regions is nonspecific. Therefore, you must consider the procedures as occurring in the same lobe, which eliminates billing additional transbronchial lung biopsies (+31632, ... with transbronchial lung biopsy[s], each additional lobe [list separately in addition to code for primary procedure]).

Error averted: You should not charge for the diagnostic bronchoscopy (31622, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]). CPT designates 31622 as a " separate procedure," meaning you should bill that code only when no other procedure is billed in the same area.

Why: The endoscopy rule makes the diagnostic service a component of any treatment procedures. So when a diagnostic bronchoscopy leads to a treatment or biopsy, you code the treatments/biopsy and not the diagnostic portion. Work units for 31622 are already built in to the treatment/biopsy bronchoscopic codes. The pulmonologist should receive credit for inserting the bronchoscope only once, not multiple times.