Pulmonology Coding Alert

Question: Our pulmonologist dictated a bronchoscopy note saying, “copious amounts of mucopurulent, brownish material noted in all airways. These were removed with suction and lavage, and samples were sent to lab for routine studies.” Should we code this with 31622 or 31624?

Arkansas Subscriber

Answer: Although 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)) and 31624 (… with bronchial alveolar lavage) sound very similar, you will need to determine whether bronchoalveolar lavage is documented in the notes before you can report 31624.

Bronchoalveolar lavage is different in comparison to a cell washing procedure (captured by 31622). A bronchoalveolar lavage implies the instillation of “larger” quantities of saline than for a “simple” bronchial washing, often done as part of a diagnostic bronchoscopy to evaluate for malignancy in which a biopsy, bronchial brushings, and washings are collected. The bronchoalveolar lavage is often done in patients with unexplained infiltrates in which an opportunistic infection is a part of the differential diagnosis.

Tip: It is sometimes easy to identify the right code if you go through the procedure notes in detail. If your pulmonologist has performed a bronchoalveolar lavage, you will see the procedure notes carrying details such as “infused 75 ml of saline and suctioned back 30 ml of fluid.” This will be an indication that your provider likely performed a service described by 31624.