Pulmonology Coding Alert

Question: AMA CPT^® guidelines state, “Surgical bronchoscopy always includes diagnostic bronchoscopy when performed by the same physician.” I’ve noticed that several of the bronchoscopy codes, such as 31623-31625, are performed to diagnose a problem, but 31622 is the only code with “diagnostic” specifically called out in the descriptor.

Does “diagnostic” have a specific meaning for these bronchoscopy codes? Is every code requiring some procedure work beyond washing (e.g., brushing, biopsy) considered “surgical” and not “diagnostic” for coding purposes?

Illinois Subscriber

Answer: According to CPT^®, “diagnostic” relates to the base procedure in a family of codes. If the provider performs a service that is visual in nature without any additional effort or intervention, then you’d assign the diagnostic code — 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)), for example.

When a provider obtains brushings to send off to pathology, like with 31623 (… with brushing or protected brushings), the service is technically considered a “surgical” procedure with respect to the CPT^® family of bronchoscopy codes. Even though the specimen will be used to diagnose a possible issue, CPT^® doesn’t regard the brushing a diagnostic service. “The brushing requires more than a visual exam. It requires manipulation of the tissue to obtain the specimen. Because the visual exam is required to identify the potential areas of concern (requiring further manipulation/intervention within those areas), you cannot code for the diagnostic base service in addition to the intervention/surgical service,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia.

The overall effort and value of the surgical service includes the effort and value of the diagnostic service. Reporting both the surgical (31623) and diagnostic (31622) services of the bronchoscopy code family on the same date would result in a duplicate payment.