Pulmonology Coding Alert

Question: My pulmonologist performed a bronchoscopy (31622, Bronchoscopy [rigid or flexible]; diagnostic, with or without cell washing [separate procedure]) with left-upper lobe biopsies (31625) and a left-upper lobe brushing (31623) on the same day. Should I attach modifier -51 or -59 for the multiple procedures? How will a modifier affect payment?

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Answer: You should attach modifier -51 (Multiple procedures) to secondary procedure 31623, not -59 (Distinct procedural service), which is typically used when attempting to separate bundled codes. Modifier  -51 covers related multiple procedures during the same provider session, not including those captured by add-on codes or those codes the CPT manual identifies as modifier -51 exempt. Always check with your carrier before you use this modifier some insurers will only reimburse for the highest-valued procedure and consider the other procedures bundled.
 
Since bronchoscopy falls under the multiple endoscopies payment rule, if you report modifier -51 you will receive a payment reduction for every procedure after primary treatment (31625), which receives full reimbursement. The insurer only wants to pay the base amount once. For example, HGSAdministrators of Camp Hill and Williamsport, Pa., reimburses you the full $187.36 for 31625. To figure the payment for the secondary procedure, the carrier would subtract 31622 ($158.09) from 31623 ($161.45), and pay you whats left over $3.36.