Pulmonology Coding Alert

Question: I was going through the CCI edits checker and I know that 31624 and 31629 are not bundled. My question is that I want to know if these two procedural codes are in the same "family" of scopes where only one is paid.

Alabama Subscriber 

Answer: You are right about the information that 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) and 31629 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) are not bundled as per the guidelines laid down by the Correct Coding Initiative (CCI) edits. Both these procedures are in the same "family" of bronchoscopy codes under the basic diagnostic bronchoscopy code 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]).

When both the procedures described by 31624 and 31629 are performed by your pulmonologist, you will get payments for both the procedures but multiple endoscopic rules will apply.

As per the multiple endoscopic rules, the procedure with the higher reimbursement value will get paid out at 100 percent of the appropriated fee and the other procedure will get paid at a value equivalent to the difference between its allowable fee and the fee allocated for the basic diagnostic procedure under the family of scopes.

So, in this case 31629 with a higher reimbursement value will be paid out at 100 percent of its appropriated fee. 31624 will be paid at the allowable fee minus the base (diagnostic) fee for 31622. The payment for 31622 is included in the payment for the highest-valued procedure. Since this payment is "built in" to the intervention codes you cannot be paid for the diagnostic portion more than once. Therefore you have to subtract this dollar amount from the relative value of the remaining procedures performed that day.