Pulmonology Coding Alert

Question: I'm trying to figure out when therapeutic aspiration is subsequent, that is, if on May 1 I use 31645, would I use 31646 if the physician completed another aspiration again on May 1 only, or would I use 31646 for any subsequent day during the same hospitalization?

Michigan Subscriber

Answer: We do not have much guidance for reporting codes 31645 (Bronchoscopy [rigid or flexible]; with therapeutic aspiration of tracheo-bronchial tree, initial [e.g., drainage of lung abscess]) and 31646 (... with therapeutic aspiration of tracheo-bronchial tree, subsequent). These codes describe procedures that the National Correct Coding Initiative considers mutually exclusive. Each procedure has a global day package of "0," which means that you can report each service only once per day.

When reporting 31646, because this procedure is a "reclearing" of the patient's airways, you should only report this code for the same date if the physician has clearly documented that the reclearing occurred at a separate session.

In such a case when you have appropriate documentation, you should append modifier -59 (Distinct procedural service) to 31646 to indicate that the physician performed this procedure separately and distinctly from 31645. If the physician had to clear the patient's airways on two separate days, you can report 31645 for both days unless your local carrier advises otherwise.