Wiki EBUS Bundling Issue

[CTraynham]

Our providers are performing both EBUS biopsies as well as video/direct visualization endobronchial biopsies during the same bronchoscopy session. Per NCCI, we are unable to bill 31625 & 31652 or 31653 together. Also, per NCCI, we are unable to bill 31623-bronchoscopy with bronchial brushings- when 31652 or 31653 is also billed during the same bronchoscopy session. Has anyone else had this issue or have any additional information as to why these edits were created? This seems unfair to the providers trying to do as much as possible during one bronchoscopy.

 

[2rjjapetal]

we are having the same issue. I am searching for any type of information to help explain this better. It doesn't seem correct, that is for sure

 

[hoosiermom5]

following, I've looked and have found nothing of any help. It's almost like they made these codes with zero guidance on how to use them.

 

[CTraynham]

Agree! I am coming up empty on all of my searches as well.

 

[amsmith]

To add to the confuision

I have received two articles (ATS and AABIP both February issues) from my providers in the past 2 days that state we can no longer use the 31629, 31628, 31633 or 31632 with the new codes... although there is not an edit for them. I almost think they created the edits for the 31623 and 31624 in error and intended to edit on the 31629, 31628, 31633 and 31632. Any thoughts?

 

[ktyyler1@yahoo.com]

I just found an alert from ATS News that due to a CMS NCCI processing error with EBUS codes, ATS is advising members to hold submission of claims for EBUS code services (31652-31654) until after April 1, 2016. The corrections will be done on the next NCCi update on April 1, 2016. Here is the link: http://news.thoracic.org/?p=8072

 

[zuzu7400]

EBUS bundling

+31654
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (EBUS)
during bronchoscopic diagnostic or therapeutic interventions(s) for peripheral lesion(s) (List separately in addition to code for primary
procedure)
NOTE: Use 31654 in conjunction with 31622, 31623, 31624, 31625, 31626, 31628, 31629, 31640, 31643, 31645, 31646.

NOTE: Report 31652, 31653, 31654 only once per session.

The following CPT codes may be reported for bronchoscopy biopsy procedures:
31623 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings
31625 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single
or multiple sites
31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe
31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea,
main stem and/or lobar bronchus(i)
+31632 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe
(List separately in addition to code for primary procedure)
+31633 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), each
additional lobe (List separately in addition to code for primary procedure)

NOTE: CPT codes 31628 and 31632 should be reported only once, regardless of how many transbronchial lung biopsies are performed in a lobe.
NOTE: CPT code 31629 should be reported only once for upper airway biopsies, regardless of how many transbronchial needle aspiration biopsies are
performed in the upper airway or in a lobe.
NOTE: CPT code 31633 should be reported only once, regardless of how many transbronchial needle aspiration biopsies are performed in the trachea or the
additional lobe.
†American Medical Association. CPT 2016 Professional Edition. Chicago, IL: American Medical Association; 2015: 179.

 

[ROSEMARYHOLLIDAY]

CCI error with 1Q16 EBUS code pair

re: your question below, there was a large volume of erroneous CCI edits in 1Q16 which now appear to be corrected in the 4/1/16 version of NCCI. We don't believe CMS provided any notification on these reported errors through transmittals or MLNs. It appears that there was very good advocacy by Denise Merlino and AMA physicians alerting the NCCI contractor of the errors. In looking through our pre-release NCCI edits in our tool, the code pair errors were removed. You want to have your patient accounting department coordinate with the MAC on reprocessing instructions so you can be paid correctly (unless CMS comes out with guidance on how this will be retroactively addressed). Also be sure your CDM was set up correctly in January with appropriate pricing and code usage strategies. The add on concept differs for 2016's codes. also, Any Medicare OSAF file market data on EBUS will be based only on the 'add on' code rate structure. January 1st prices would have needed to have been built for the higher work values and differentiate between all three of the new codes.

Our providers are performing both EBUS biopsies as well as video/direct visualization endobronchial biopsies during the same bronchoscopy session. Per NCCI, we are unable to bill 31625 & 31652 or 31653 together. Also, per NCCI, we are unable to bill 31623-bronchoscopy with bronchial brushings- when 31652 or 31653 is also billed during the same bronchoscopy session. Has anyone else had this issue or have any additional information as to why these edits were created? This seems unfair to the providers trying to do as much as possible during one bronchoscopy.