Pulmonology Coding Alert

Question: A patient has a perihilar 0.5-cm nodule in the right lower lobe and a 1.5-cm subcarinal lymph node. The pulmonologist performs a bronchoscopy and passes a transbronchial biopsy needle through the carina. He then obtains aspiration biopsies from the subcarinal lymph node.

The pulmonologist couldn't use a biopsy forceps to reach the perihilar nodule in the right lower lobe and, under fluoroscopic guidance, obtains two transbronchial needle aspiration biopsies. He submits biopsy specimens separately from the two anatomic sites.

Should I report the transbronchial needle aspiration biopsies in addition to the biopsies from the subcarinal lymph node?


Utah Subscriber


Answer: Yes. Because the pulmonologist biopsies different lobes, you should report both bronchoscopies.

You should report the aspiration biopsies from the subcarinal lymph node with 31629 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]).

For the two transbronchial needle aspiration biopsies in the right lower lobe, assign +31633 (... with transbronchial needle aspiration biopsy[s], each additional lobe [list separately in addition to code for primary procedure]).

Caution: Although the pulmonologist obtained two specimens from the right lower lobe via needle aspiration, you should report 31633 only once. The code includes all specimens that the physician obtains in a given lobe.