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Answer: Your answer depends on whether it was an endobronchial biopsy or a transbronchial biopsy. If it was an endobronchial biopsy, the applicable code would be 31625 (bronchoscopy with biopsy). A transbronchial biopsy would be 31628 (bronchoscopy with transbronchial lung biopsy, with or without fluoroscopic guidance). If an endobronchial biopsy were to be performed on one or more lobes, 31625 would only be coded once because it is a singular procedure. Washings are bundled into the bronchoscopy code 31622 (bronchoscopy [rigid or flexible]; diagnostic, with or without cell washing [separate procedure]). Cell brushing would be coded 31623 (... with brushing or protected brushings).
If brushings were provided for a different area of the lungs, and were documented as such, you would code 31623 with modifier -59 (distinct procedural service), because each brushing is separate. If the brushings were performed in the same area, you would code 31623 and add modifier -51 (multiple procedures). The primary procedure, in this case the procedure that accompanied the brushings, should be listed as such. Following the reimbursement on this, some practices may find that their local carriers may deny subsequent bronchoscopies (i.e., the brushings, 31623, which were not performed during a separate session), but Medicare generally pays them at a lesser amount.
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