Pulmonology Coding Alert

Answer: Yes, there is no bundling between these codes. All three procedures can be reported without modifiers. You should code the bronchial alveolar lavage (BAL) in the patient with localized pneumonia with a 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) and a protected brushing with 31623 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings). She may or may not use fluoroscopic guidance to perform this test. She may have performed the brushing or protected brushing with a soft brush to gently wipe the lung tissue or to scrape the lesion. You should code the transbronchial lung biopsy with 31628 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe). Remember that you can report 31628 only once regardless of how many transbronchial lung biopsies are performed in a lobe all during the same session. “If additional biopsies are performed in other lobes, you can also report 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]) along with 31628. No modifier is needed with 31632 since this is an add-on code, and can only be reported with its primary code, 31628. Code 31632 can be reported once per additional lobe. Documentation should be clear in identifying all of the lobes that underwent transbronchial biopsy,” adds Carol Pohlig, BSN, RN, CPC, ACS, Senior Coding & Education Specialist at the Hospital of the University of Pennsylvania.

 

One of the keys to understanding bronchoscopy coding and billing is to be familiar with Medicare’s Multiple Endoscopy Rule. During most bronchoscopies, a number of different procedures may occur, and each should be coded separately. Make sure to list the most complex procedure first (Transbronchial lung biopsy, 31628), followed by the less complex codes for protected brushing (31623) and BAL (31624). Unfortunately, the total reimbursement is not the sum of each bronchoscopy procedure payment. The Multiple Endoscopy Rule dictates that the most complex code is reimbursed fully, and the other codes are reimbursed as the difference between the code and the base bronchoscopy code (31622). Therefore, expect full payment only for the biopsy. The current national reimbursement rate for code 31628 performed in a facility is $195.95. Payment for 31622 is included in the payment for the most complex bronchoscopic procedure, but needs to be subtracted from the other bronchoscopy codes. 

 

“It is likely that the procedure took place on a day different from the new patient encounter, in which the visit can be billedwith any of the codes from 99201-99205 for evaluation and management for new patients. In general, if the physician encounter results in the decision to perform a procedure, both the visit and the procedure can be billed. If the procedure was planned during a previous encounter, then the H&P that occurs on procedure day to update the patient’s physician status (which is a required clinical component of the procedure) is not separately billable since there is no additional management of a separate problem,” says Pohlig.