Pulmonology Coding Alert
Count Lobes, Not Sites When Reporting TBNA Procedures
Question: My physician is billing for a transbronchial needle aspiration (TBNA) in the right paratracheal lymph node cluster, then advanced into the bronchus intermedius, rotated laterally, and biopsied the group of enlarged right hilar lymph nodes. My question is how do you know when you are supposed to bill for an additional lobe? This procedure was not performed in different lobes but on different sites of the same lobe similar to TBNA in the right and left hilar lymph node. Also, let me know when would you use 31633?
Answer: You will bill 31629 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) for the right paratrachealcluster since these are present in the right upper lobe. Since the descriptor of 31629 includes biopsies or a single biopsy, you will have to report this code only once irrespective of the number of samples taken. You will also report 31633 for the set of aspiration biopsies performed on the right hilar lymph nodes since these are present in the right lower lobe.
Because pulmonologists often refer to the nodes instead of their relationship to the lobe position, CPT Assistant published a chart that is helpful for coders to distinguish the locations of each node (https://catalog.ama-assn.org/MEDIA/ProductCatalog/m2010182/CPTAssistantNovember2009.pdf).
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Pulmonology Coding Alert
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