General Surgery Coding Alert

Question: A patient with interstitial lung disease reported for a bronchial alveolar lavage procedure so the surgeon could collect specimens for cellular analysis. The patient was prepped and moderate sedation administered, but the procedure was halted due to patient dyspnea. We billed the procedure with modifier 53, but the Medicare payer states that this is an invalid modifier for this service. How should we bill the case?

California Subscriber

Answer: The correct code for the procedure is 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage). Although it is correct to use modifier 53 (Discontinued procedure) in this case, some payers won’t accept that modifier. Instead, they ask the surgeon to bill the code that best describes the service that was completed.

For instance, if the surgeon began the bronchoscopy but wasn’t able to complete the procedure to collect the BAL specimens, you might report 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]).

If the procedure is not started, you might bill only an E/M code, or you might bill the sedation but no surgical code in a case like this.