Pulmonology Coding Alert

Question: The pulmonologist in our practice performed a transbronchial biopsy in the patient's left upper lobe. The pulmonologist notes that he performed a saline lavage bilaterally and removed all visible secretions from the tracheobronchial tree. Should I report any other services with code 31628? 


New York Subscriber


Answer: The details of the "lavage" are very important. If the operative report states that the pulmonologist obtained sterile saline washings of the bronchus and sends the washings for culture and cytologic examination, you should consider this procedure as "cell washings."

Cell washings involve the aspiration of secretions or small amounts of instilled saline from larger airways. Carriers consider cell washing as part of the integral service (31622, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]), and you should not report the cell washing separately. 

Bronchial alveolar lavage (31624, ... with bronchial alveolar lavage) varies from "cell washing" in that it allows the recovery of cells as well as noncellular components from the epithelial surface of the lower respiratory tract. 

During this procedure, the pulmonologist wedges a bronchoscope into the area he wants to study. He administers saline through the bronchoscope and then aspirates the fluid into a sterile syringe or trap. You can report alveolar lavage (31624) in addition to 31628 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy[s], single lobe).