Wiki Bronchoscopy Coding - 31623 and 31628

[billylewis]

Does any one know why 31623 and 31628 cannot be billed separately for Cigna and DC Medicaid? According to CCI, if I am reading it correctly, these codes can be billed separately... rather, I don't see that they cannot be billed separtely. Any information would be greatly appreciated!

 

[lisigirl]

I don't know why Cigna would bundle these codes. I would believe that Medicaid did simply because Medicaid will bundle anything it can to pay less!

These codes do not bundle under CCI and I always billed them together. However, they do get paid based on endoscopic payment rules. In this case, CPT 31623 has the same RVUs as the base code (which is 31622). Once you subtract the RVUs of the base code, there aren't any RVUs left so no payment would be made on 31623.

Are you sure Cigna bundled these codes because they may have just paid based on these payment rules.

Lisi, CPC
eharkler@nmh.org

 

[billylewis]

I failed to include the other codes that were billed as well.
31627, 31628, 31624 and 31623 --> all paid except for the 31623 (why is this?)
Do you know why 31624 was paid? According to mult endoscopy rule you subtract all subseq bronch codes from base 31622 code. Wouldn't this mean that 31624 shouldn't have been paid? Am I understanding the mult endosc rule correctly? Thanks!