Pulmonology Coding Alert

Question: Our physician performed the following procedures during a fiberoptic bronchoscopy: an airway evaluation, an EBUS-guided BTNA of 7 stations, endobronchial biopsies of the left lower lobe, cytologic brushings of the same lobe, and bronchioalveolar lavage of the left lobe, as well. Can you help with codes for these services?

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Answer: Taking the procedures in the order you’ve presented them, you’d report your physician’s services as follows:

You’ll use CPT^® code 31653 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures) for your physician’s endobronchial ultrasound (EBUS) bronchoscopic transparenchymal nodule access (BTNA) procedure.

Don’t miss: Code 31653 specifies “3 or more…lymph node stations,” which would cover the seven stations specified in your physician’s note.

Guidance tip: CPT^® Guidelines specify that 31653 is a complete service “used for sampling (eg, aspiration/biopsy) lymph node(s) or adjacent structure(s) utilizing endobronchial ultrasound (EBUS) and is reported separately.

Endobronchial services: Your physician’s endobronchial biopsies of the left lower lobe are best described by code 31625 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites) to reflect the biopsies taken in that location.

For the cytologic brushings of the left lower lobe, you’ll report 31623 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings).

And you’ll also include code 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) for your physician’s bronchioaveolar lavage of left lower lobe.

And just to point out one more thing: You would not bill the diagnostic airway evaluation (first in your list) as a separate procedure since CPT^® Guidelines specify that surgical bronchoscopy “always includes diagnostic bronchoscopy when performed by the same physician.”

FYI: CCI edits designate code 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]) as a column 2 code with codes 31624, 31625, 31653 listed above and these should not be billed together in any circumstances.

Note: The phrase “separate procedure” at the end of code 31622 description indicates you should use this code only when the physician performs no other procedures in that anatomical area.