Pulmonology Coding Alert

Question: A pulmonologist performed a bronch/wash, thoracentesis with tube and chemical intrapleural on the same day. When the pulmonologist performs his bronchs, he usually always looks at the right and left lungs. Should I bill 31622 multiple times?


Colorado Subscriber


Answer: No. You should report only one unit of 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]). Right and left sides do not apply for bronchoscopic procedures (31622-31656).

Exceptions: If the bronchoscopy results in multiple transbronchial biopsies of two or more lobes, you should report each lobe's procedure. For the biopsies on the first lobe, assign 31628 (... with transbronchial lung biopsy[s], single lobe). Report biopsy(ies) of the second lobe with add-on code +31632 (... with transbronchial lung biopsy[s], each additional lobe [list separately in addition to code for primary procedure]).

Similarly, for needle aspiration biopsies of two or more lobes, assign 31629 (... with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) for the first transbronchial needle aspiration biopsy and add-on code +31633 (... with transbronchial needle aspiration biopsy[s], each additional lobe [list separately in addition to code for primary procedure]) for the second transbronchial needle aspiration biopsy at a different site.

Do this: Code the procedures and services that you describe without any modifiers. The National Correct Coding Initiative does not place any edits on these code sets. Code the claim as follows:

• 31622 -- "bronch/wash"

• 32002-59 -- Thoracentesis with insertion of tube with or without water seal (e.g., for pneumothorax) (separate procedure) appended with modifier 59 to indicate the "thoracentesis with tube" as a distinct procedural service 

• 32005 -- Chemical pleurodesis (e.g., for recurrent or persistent pneumothorax) for the "chemical intrapleural."

Don't overlook: Although NCCI usually considers "thoracentesis with tube" (32002) a component of pleurodesis (32005), in your case reporting 32002 with modifier 59 is appropriate. The edits permit the use of a modifier when circumstances such as you describe support the separateness of the services.

Pleurodesis usually occurs with a chest tube already in place. The pulmonologist performs pleurodesis after the pleural space has been drained with a chest tube for several days. He then instills the sclerosing material after the suction has been stopped and the chest tube clamped.

In your example, the thoracentesis catheter was inserted, the space drained completely, the sclerosing material was then instilled and the catheter removed. The work involved with the thoracentesis catheter is more than instilling the sclerosing material into a chest tube. Therefore, you should code both the thoracentesis and the pleurodesis by using modifier 59 on 32002.