Pulmonology Coding Alert

Question: Can I append 59 (Distinct procedural service) to 31625 if the pulmonologist biopsies two different lobes? Would I also need to use modifier 51 (Multiple procedures) with these bronchoscopy codes?

Answer: When a pulmonologist performs a transbronchial lung biopsy in two different lobes, you may report 31628 ( Bronchoscopy, rigid or flexible, with or without fluouroscopic guidance; with transbronchial lung biopsy[s], single lobe) for the biopsy in the initial lobe, and +31632 (... with transbronchial lung biopsy[s], each additional lobe [List separately in addition to code for primary procedure]) for the biopsy taken in the additional lobe. Code +31632 is an "addon" code and doesn't require modifier 59 to indicate it is a distinct and separate service. Remember, you cannot report add-on codes by themselves, and you may use them only with an appropriate primary code (in this case 31628).

Additionally, you are not required to use modifier 51 with add-on codes. Instead, append modifier 51 to any subsequent procedure that can "stand alone" (that is, a procedure that is not satisfied by using an add-on code) and not "modifier 51 exempt" (as determined by CPT).

Example: For transbronchial needle aspiration biopsies performed in different lobes, use 31628 and add-on code +31633 (... with transbronchial needle aspiration biopsy(s), each additional lobe [List separately in addition to code for primary procedure]).

Rule: Modifier 51 also does not apply to reporting multiple bronchoscopy procedures, as bronchoscopies are governed by the multiple endoscopy rule.

You can use 31625 (... with bronchial or endobronchial biopsy[s], single or multiple sites) only for multiple bronchial biopsies taken from different lobes, and you may report this code only once per session.

Example: If the pulmonologist performs a bronchial biopsy (31625) during the same bronchoscopy session in a different lobe than a transbronchial lung biopsy (31628) or a transbronchial needle aspiration (31629), you would report the bronchial biopsy with modifier 59 (31628, 31625-59 or 31629, 31625-59).

Remember: You may report bronchial or endobronchial biopsies (31625) only once per session, regardless of the number or sites of biopsy.