Pulmonology Coding Alert

Question: A pulmonologist performs washings in the left upper lobe and bronchial alveolar lavage (BAL) in the right lower lobe. Because the physician performs the procedures in separate lobes, can I bill 31624 and 31622-59? I know that Medicare may not pay due to Correct Coding Initiative (CCI) edits, but some of the commercial carriers might.

Tennessee Subscriber

Answer: Regardless of payer, never report the code combination of 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]) and 31624 (... with bronchial alveolar lavage).

Separate lobes or right and left side do not affect coding for bronchoscopic procedures (31622-31656), except biopsy codes 31628 (... with transbronchial lung biopsy[s], single lobe), 31629 (... with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]), +31632 (... with transbronchial lung biopsy[s], each additional lobe [list separately in addition to code for primary procedure]) and +31633 (... with transbronchial needle aspiration biopsy[s], each additional lobe [list separately in addition to code for primary procedure]). The surgical procedure (such as 31624) includes the diagnostic portion of the procedure (31622), based on CPT rules.

The phrase "separate procedure" at the end of 31622's description indicates you should use this code only when the physician performs no other procedures in that anatomical area. Because this rule is based on CPT standards of practice, not Medicare-based guidelines, you should always follow this general coding principle with private payers unless you have written instructions directing you otherwise.

Because both sets of guidelines (CPT and Medicare) bundle 31622 into all other bronchoscopy services, you should only report the "surgical" procedure, the BAL, using 31624. This code involves a more complicated input/output measurement and sampling than the diagnostic bronchoscopy with bronchial washing code (31622) does.