Pulmonology Coding Alert

Question: An established patient with a cough reports to the pulmonologist complaining of breathing trouble. After a level-four E/M, the pulmonologist performs a PA, a lateral chest x-ray, and a diagnostic bronchoscopy with cell washing. During the bronchoscopy, the pulmonologist takes two bronchial biopsies. The pulmonologist performed all services in-house with the practice's equipment. Can I report two bronchoscopies on this claim?

Texas Subscriber

Answer: You will be able to report only the bronchoscopy with bronchial biopsy for this encounter.

Why? The Correct Coding Initiative (CCI) bundles diagnostic bronchoscopy (31622, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing) into all other bronchoscopy codes (31623-31656).

On the claim, report the following:

• 31625 (... with bronchial or endobronchial biopsy[s], single or multiple sites) for the bronchoscopy

• 71020 (Radiologic examination, chest, two views, frontal and lateral) for the x-ray

• 99214 (Office or other outpatient visit for the E/M of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision-making of moderate complexity) for the E/M

• modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) linked to 99214 to show that the E/M and procedures were separate services

• 786.09 (Dyspnea) linked to 31625, 71020 and 99214 to represent the patient's breathing trouble

• 786.2 (Cough) linked to 31625, 71020 and 99214 to represent the patient's cough.