Pulmonology Coding Alert

Question: Is there a code we should bill for subcutaneous lidocaine or lidocaine with epinephrine during an office procedure such as bronchoscopy? Some of the pulmonologists in our group are asking for a code for this, while others think we should count it in the procedure code. Should we bill separately for the lidocaine use?

Alaska Subscriber

Answer: The physicians in your group who state that the lidocaine should be counted as part of the procedure are partially correct. Medicare specifies that local anesthetic use is “an inherent surgical procedure component, and is not billable separately.”

Medicare includes all “surgical anesthesia” administered by the operating surgeon as part of the surgical package and not a payable service, and this would include bronchoscopy (31622, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)). You should check with private payers to see where they stand on this topic.

The only code for lidocaine is J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg). This code descriptor specifies that the physician must administer the lidocaine via an IV infusion, but it’s bundled into many procedure codes. Medicare assigns an “E” status to this code (Excluded from the Physician Fee Schedule by regulation).