Pulmonology Coding Alert

Question: A patient presented for a therapeutic aspiration to remove a blood clot in the left secondary bronchus via bronchoscopy. According to the operative report, the blood clot was partially obstructing the airway. The procedure was performed successfully.

I’m new to pulmonology coding and I’m stumped as to how to report the procedure.

Louisiana Subscriber

Answer: You’ll assign 31645 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial) to report the procedure and J98.09 (Other diseases of bronchus, not elsewhere classified) for the blood clot.

The CPT^® code set doesn’t contain a specific bronchoscopy code that explicitly mentions blood clot removal, but the “therapeutic aspiration of tracheobronchial tree” listed in the descriptor accurately represents the provider’s procedure.

Some coders may be tempted to assign a pulmonary embolism code, such as I26.99 (Other pulmonary embolism without acute cor pulmonale), which includes the additional term of pulmonary embolism not otherwise specified (NOS). This choice is incorrect because the blood clot in the situation you presented resided in the patient’s bronchial tree rather than in a pulmonary vessel.