Pulmonology Coding Alert

Question: Our pulmonologist recently assessed a patient who he had diagnosed with lung abscess. He performed a bronchoscopy on the patient and obtained a bronchoalveolar lavage sample. He also performed drainage of the lung abscess. Can I report the lavage and the drainage of the abscess separately? If so, should I use a modifier to separate the two services?

Maryland Subscriber

Answer: The scenario will need you to report two codes, one for the bronchoalveolar lavage and the other for the drainage of the lung abscess. You report the lavage performed by your clinician using the CPT^® code 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage). For the drainage of the lung abscess, you report 31645 (…with therapeutic aspiration of tracheobronchial tree, initial [e.g, drainage of lung abscess]).

As per Correct Coding Initiative (CCI) edits, there is no bundling between 31624 and 31645. For this reason, you do not have to use any modifier such as 59 (Distinct procedural service) when reporting these two bronchoscopic procedures together.

Also, it is not required for you to use a modifier such as 51 (Multiple procedures) to inform payers that two or more procedures are being reported on the same day as many payers do not require the use of this modifier.

Coding tip: As multiple endoscopic rules apply when more than one bronchoscopic procedure is being performed, it is best to report the higher valued procedure in the first line of the claim. This will help in correctly applying the reduction to the lesser-valued procedure. As 31645 is allocated higher relative value units (total RVU of 9.73), report this procedure in the first line of the claim form and then report 31624 (total RVU of 9.56) in the next line.