Pulmonology Coding Alert

Scrutinize the note for incision, biopsy details Bronchoscopies and 32100 (Thoracotomy ...)don't always go hand-in-hand. Unless a diagnostic bronchoscopy unveils a problem requiring surgery, you can't bill 31622 for the bronchoscopy with other procedures the physician performs through a thoracotomy incision, such as 32100, for a thoracotomy with exploration and biopsy.

Typical scenario: A physician performs diagnostic bronchoscopy. Based on the results of the bronchoscopy, he recommends thoracic surgery when the scope identifies a problem that requires a thoracic procedure.

Look at the following case example provided by Anne-Marie Miklos, CPC, coding consultant in Winter Springs, Fla., to learn more about reporting a bronchoscopy when the physician performs a thoracotomy. Step 1: Review the Preliminary Details A 54-year-old long-term smoker with hemoptysis (786.3) and dizziness (780.4) comes to your surgical practice. Results from a chest x-ray indicate right hilar fullness. A computed tomography image (CT scan) shows a right hilar mass abutting the superior vena cava and aorta with possible right upper lobe infiltrate with multiple lymph nodes. The physician decides to perform a biopsy to remove the mass. Step 2: Look for Biopsy Details in the Procedure Note In the operating room, the surgeon places a double lumen endotracheal tube and performs fiberoptic bronchoscopy to check the position of the endotracheal tube in the left mainstem bronchus. The nurse anesthetist places Foley catheters, administers anesthesia, and places a radial artery catheter for postoperative blood gas management.

The physician then makes a posterolateral thoracotomy incision and develops subcutaneous flaps. He identifies an auscultatory triangle and enters the right pleural space through the sixth intercostal space. He takes the right lung out of the ventilatory circuit and then manually palpates the lung.

In the proximal portion of the right upper lobe, the physician palpates an inflammatory mass. The physician performs a needle biopsy and sends the specimen to pathology. The physician excises the hilum and identifies multiple adenopathies in the right paratracheal, subazygos and posterior hilar areas. All of these specimens go to pathology for frozen sections, and all return with the diagnosis of inflammatory fibrosis (515).

Consequently, the physician incises the mass and carries out an incisional biopsy. Then, the physician sends all of the tissue separately for cultures.

He oversews the incisional biopsy with 4-0 Prolene, places chest tubes, reapproximates the ribs, and closes the auscultatory triangle. Step 3: Here's What You Should Report You should begin with the fiberoptic bronchoscopy identified in the report, Miklos says. The physician clearly says he performed the bronchoscopy, but the reason for doing so is to determine if the endotracheal tube is in the correct position, Miklos says.

Hint: In this case, you should not code the bronchoscopy (31622, Bronchoscopy, rigid or flexible ...; diagnostic, [...]