Wiki 32551 and 31622?

[pgrila]

Can I bill 32551 chest tube and 31622 Bronchoscopy with Modifer 59 with the main procedure of 32484 Removal of lung, other than total pneumonectomy; single segment (segmentectomy)? Where do I find these guidelines in writing?
Help please!

 

[monbel]

You can't bill for the chest tube. It's included in the procedure. Per general coding guidelines for cpt 32551 "a tube thoracostomy (CPT code 32020 (32551 in 2008)) may be performed for drainage of an abscess, empyema, or hemothorax. The code descriptor for CPT code 32020 (32551 in 2008) defines it as a “separate procedure”. It is not separately reportable when performed at the same patient encounter as another open procedure on the ipsilateral side of the thorax. 31622
CPT 31622 can't be billed either: When a diagnostic or surgical endoscopy of the respiratory system is performed, it is a standard of practice to evaluate the access regions. A separate HCPCS/CPT code should not be reported for this evaluation of the access regions. For example, if an endoscopic anterior ethmoidectomy is performed, a diagnostic nasal endoscopy should not be reported separately simply because the approach to the ethmoid sinus is transnasal. Similarly, fiberoptic bronchoscopy routinely includes an examination of the nasal cavity, pharynx, and larynx. A separate HCPCS/CPT code should not be reported with the bronchoscopy HCPCS/CPT code for this latter examination whether it is limited (“cursory”) or complete.
If medically reasonable and necessary endoscopic procedures are performed on two regions of the respiratory system with different types of endoscopes, both procedures may be separately reportable. For example, if a patient requires diagnostic bronchoscopy for a lung mass with a fiberoptic bronchoscope and a separate laryngoscopy for a laryngeal mass with a fiberoptic laryngoscope at the same patient encounter, HCPCS/CPT codes for both procedures may be reported separately. It must be medically
reasonable and necessary to utilize two separate endoscopes to report both codes.
If the findings of a diagnostic endoscopy lead to the performance of a non-endoscopic surgical procedure at the same patient encounter, the diagnostic endoscopy may be reported separately. However, if a “scout” endoscopic procedure to evaluate the surgical field (e.g., confirmation of anatomic structures, assess extent of disease, confirmation of adequacy of surgical procedure such as tracheostomy) is performed at the same patient encounter as an open surgical procedure, the endoscopic procedure is not separately payable.

http://www.cms.hhs.gov/NationalCorrectCodInitEd/

Hope this helps you!