Pulmonology Coding Alert

Question: How do you code a bronchoscopy that is done through an established tracheostomy? Frequently our physicians will perform a therapeutic bronchoscopy (31645), but instead of using a nasal approach, they enter through the established tracheostomy endotracheal tube. There has been discussion on how we should code this. Using 31615 doesnt seem appropriate because it doesnt include any of the work that is performed during therapeutic or other bronchoscopies. Because the approach is different, should I use 31899 supported with operative notes? Or would it be more appropriate to use 31645?

Virginia Subscriber

Answer: This is a good question with no clear correct answer, but there are several options that you can weigh. You are right that it is incorrect to use 31615 (Tracheobronchoscopy through established tracheostomy incision) for this procedure. Code 31615 is just a look through the tracheostomy and doesnt include any other maneuvers.

Many practices may choose to code the therapeutic bronchoscopy through the tracheostomy with 31645 (Bronchoscopy [rigid or flexible]; with therapeutic aspiration of tracheobronchial tree, initial [e.g.,drainage of lung abscess]). This choice, however, isnt exactly correct since the pulmonologist introduced the bronchoscope through the tracheostomy and not through the nares or mouth. One solution is to report 31645 with modifier 52 to represent a reduced service. This would allow payment for exactly what took place. Submit the claim with the same charge as 31645. You should never independently reduce the fee. Let the payer determine what they are going to pay based on what you report. The 52 modifier, of course, will trigger documentation review prior to payment.

Since there is technically no correct code for this procedure, 31899 (Unlisted procedure, trachea, bronchi) is also a good option. Reporting 31899 is always acceptable when there is no procedure code that represents the actual service performed. Remember, the payer will request documentation before providing payment to identify what has been done. Make sure the pulmonologist inserts a procedure description on the claim form as well as a fee for any unlisted procedures.