Better Bronchoscopy in 2016

Better Bronchoscopy in 2016

Consider the changes and apply the rules for three new EBUS codes.

CPT® 2016 introduced three new codes to describe endobronchial ultrasound (EBUS). Here’s what you need to know to report these services correctly.

Reporting EBUS

EBUS combines a bronchoscope with ultrasound to visualize the bronchi and adjacent structures, and to obtain tissue for biopsy.

In past years, CPT® designated add-on code 31620 to describe EBUS during diagnostic or therapeutic bronchoscopy. For 2016, 31620 was deleted and replaced by two, new standalone codes to describe EBUS for the purpose of obtaining transtracheal and transbronchial sampling:

31652 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures

31653 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures

You may report a single unit of either 31652 or 31653 (but not both), per session, depending on the number of lymph node stations or structures from which tissue is obtained. As an example of proper 31652 use, CPT® Changes 2016: An Insider’s View offers, “In a patient with known or suspected lung cancer, endobronchial ultrasound is used to identify and aspirate/biopsy on mediastinal and one hilar lymph node station.”

Note that sampling by EBUS differs from transbronchial lung biopsy(s) (+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)) and transbronchial needle aspiration biopsy(s) (+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)), neither of which include an ultrasound component.

Note: For 2016, CPT® includes moderate sedation, when provided, with 31632.

Call on 31654 for Peripheral Lesions

CPT® 2016 also created an add-on code to describe EBUS for a diagnostic or therapeutic intervention of peripheral lesions.

+31654 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s])

When appropriate, you may report a single unit of +31654, per session, in addition to primary procedures 31622-31626, 31628-31629, 31640, 31643, or 31645-31646.

CPT® Changes 2016: An Insider’s View provides as an example scenario, “A patient presents with a 1.5-cm peripheral lung lesion. The lesion is identified with transendoscopic ultrasound probe guidance.”

For instance, when reporting 31625 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites, if one or more biopsies are taken using EBUS, you would report +31654, as well.


 

Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, is vice president of Stark Coding and Consulting, LLC., in Shrewsbury, N.J. She is an approved ICD-10 instructor, and a past member of the AAPC National Advisory Board and executive board. Cobuzzi owned a medical billing company for 13 years before becoming a full time consultant. She is a speaker for many local and national organizations and a member of the Monmouth, N.J., local chapter.

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