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Pulmonology Coding Alert

You Be the Coder:

Check Your Options for Procedures Performed Through Established Trach

Published on Sun Nov 25, 2012

Question: Our pulmonologist performed bronchoscopy through established trach (patient is vent dependent) - findings were mucus plugs in left lung and small 3 mm endobrachial lesion at start of middle lobe bronchus, right lung. I know 31615 covers bronchoscopy through trach but will this code cover the biopsy and mucus plug suction? I had come up with 31615 and 31624 and 31625 but CCI edit states 31624 and 31625 are part of 31615 - any help would be appreciated! Michigan Subscriber Answer: When your pulmonologist performs a bronchoscopy through an established tracheostomy, you can report it with 31615 (Tracheobronchoscopy through established tracheostomy incision). However, it is vital to remember that 31615 can be used only when your pulmonologist views the airways without performing any other procedure. You do not have any specific code to report a procedure such as a biopsy through an established tracheostomy, as is the case in the scenario that you have described. Also, as you have correct noted, you cannot report 31624 ( Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) or 31625 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy[s], single or multiple sites) along with 31615 as it runs up Correct Coding Initiative (CCI) edits that do not allow these codes to report them together. So, in this case you are left with the option of reporting 31624 and 31625 along with the modifier 52 ( Reduced services) attached to it as the procedure was done through the tracheostomy instead of the conventional approach through the nose or the mouth. Attach documentation to let the payer know that the procedure was conducted through the tracheostomy site and this is the reason that you are reporting the code with a 52 modifier attached to it. Or else, you can settle down to report the procedures using the unlisted procedure code 31899 ( Unlisted procedure, trachea, bronchi). You can report 31899 when there is no procedural code to describe the procedures that have been performed by your pulmonologist. However, you will need to provide proper documentation along with your claim describing in detail what procedures your pulmonologist has performed along with a fee that you plan to request for the procedures.

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