Pulmonology Coding Alert

Question: If a patient has an initial and a subsequent therapeutic bronchoscopy on the same date of service, we would typically report 31645 and 31646 with modifier 59. But what should we code if the pulmonologist performs this procedure on day one of the patient's admit, and then repeats it on day four of his hospital stay?

Michigan Subscriber

Answer: Codes 31645 (Bronchoscopy [rigid or flexible]; with therapeutic aspiration of tracheobronchial  tree, initial [e.g., drainage of lung abscess]) and 31646 (... with therapeutic aspiration of tracheobronchial tree, subsequent) are considered "mutually exclusive" when performed at the same session.

This edit exists in order to prevent physicians from  reporting both codes for multiple aspiration attempts during the same session. Therefore, if the pulmonologist performs an initial and subsequent aspiration during two separate sessions on the same calendar day, you can report 31645 and 31646-59 (Distinct procedural service).

If the physician performs a therapeutic bronchoscopy on day one and repeats the procedure on day four, then you should report 31645 on day one and 31646 on day four along with the proper E/M code for initial or subsequent services and append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M (as appropriate).