Pulmonology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: What is the best way to code a complex bronchoscopy? Our pulmonologist does a lung biopsy and needle aspirations with brushings. We have been coding 31628, 31623-51 and 31629-59. We get paid well for the first procedure, but the second and third codes are being reimbursed at about $2-$10 at the most. How can I get better payments for the later procedures that take more time than they are given credit for? California Subscriber  


Answer: You are correct in coding 31628 (Bronchoscopy [rigid or flexible]; with transbronchial lung biopsy, with or without fluoroscopic guidance), 31623 (... with brushing or protected brushings) and 31629 (... with transbronchial needle aspiration biopsy). None of these codes are bundled by the Correct Coding Initiative (CCI). Therefore, you should code the procedures as follows: 31628 31629-51 (Multiple procedures) 31623-51. Following CMS guidelines in section 4826 of the Medicare Carriers Manual, these procedures are related endoscopies and are reimbursed following the multiple-endoscopy rule. Medicare will pay the full value for 31628 and the difference between each other procedure and the base code (31622). Unfortunately, these last procedures will not be reimbursed for much more than you are receiving.

If your physicians believe that they are not being fairly compensated for their time and effort related to the procedures listed above, then they should contact their specialty society to request that CMS review the work value for these procedures.