I code for thoracic and pulmonary and am having some confusion about how many different biopsies and FNAs I can bill at one session. For example:
ESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was placed in the operating room. Appropriate timeout had occurred, and the patient was intubated for the procedure using laryngeal mask airway. Initially, a traditional bronchoscopy revealed a slightly tortuous airway with scant secretions noted scattered throughout. There was erythematous mucosa noted throughout the tracheobronchial tree with several yellowish nodules. A representative nodule was seen in the first division right. This was biopsied by endobronchial biopsy with forceps and sent for routine pathology. Following this, I performed a bronchial alveolar lavage in the right middle lobe lateral segment. This was sent for routine cultures as well as cytology and flow cytometry; and 150 mL were instilled and approximately 50 mL of cloudy fluid was returned. Following this, a wash of the right lung was obtained and sent for routine cultures. Following this, I performed transbronchial biopsies in the area of the right upper lobe. These were sent for pathology as well. Additionally, endobronchial biopsies of the main carina were obtained, and these were also sent for pathology.
After this, we transitioned to endobronchial ultrasound, performing an ultrasound-guided needle aspiration of the station 7 lymph node. This was well visualized, and pathology was available on site to confirm lymph node material. I did also send cultures of the station 7 lymph node aspirate for a fungal and AFB culture. I sent final aspirations with lengthened endobronchial ultrasound needle with suctioning for final pathology review. Preliminary diagnosis showed clusters of white blood cells with no discrete granulomas seen so far.
I have so far 31624, 31625, 31628, 31620 and what about the FNA 31629?
ESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was placed in the operating room. Appropriate timeout had occurred, and the patient was intubated for the procedure using laryngeal mask airway. Initially, a traditional bronchoscopy revealed a slightly tortuous airway with scant secretions noted scattered throughout. There was erythematous mucosa noted throughout the tracheobronchial tree with several yellowish nodules. A representative nodule was seen in the first division right. This was biopsied by endobronchial biopsy with forceps and sent for routine pathology. Following this, I performed a bronchial alveolar lavage in the right middle lobe lateral segment. This was sent for routine cultures as well as cytology and flow cytometry; and 150 mL were instilled and approximately 50 mL of cloudy fluid was returned. Following this, a wash of the right lung was obtained and sent for routine cultures. Following this, I performed transbronchial biopsies in the area of the right upper lobe. These were sent for pathology as well. Additionally, endobronchial biopsies of the main carina were obtained, and these were also sent for pathology.
After this, we transitioned to endobronchial ultrasound, performing an ultrasound-guided needle aspiration of the station 7 lymph node. This was well visualized, and pathology was available on site to confirm lymph node material. I did also send cultures of the station 7 lymph node aspirate for a fungal and AFB culture. I sent final aspirations with lengthened endobronchial ultrasound needle with suctioning for final pathology review. Preliminary diagnosis showed clusters of white blood cells with no discrete granulomas seen so far.
I have so far 31624, 31625, 31628, 31620 and what about the FNA 31629?