Pulmonology Coding Alert

Learn the basics to achieve flawless bronchoscopy coding

When your pulmonologist performs a cell washing or a lavage, you'll need to determine whether 31622 or 31624 is most appropriate code to use. Best bet: Look at the physician's details of the procedure in the documentation for clarification.

Coders often confuse 31624 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial alveolar lavage) with a basic bronchial wash (31622, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]), says Jill Young, CPC, coding specialist with Young Medical Consulting LLC in East Lansing, Mich. Our experts explain when you should use each code.

31622 May or May Not Include Washings

You should think of 31622 as the base bronchoscopy code. When your pulmonologist performs a diagnostic bronchoscopy with or without washing, 31622 is the first code you should consider.
 
In this procedure, your physician inserts a bronchoscope through either the nasal or oral passage, advances the bronchoscope beyond the trachea, and examines the main and subsegmental airways, says Vicky V. O'Neil, CPC, CCS-P, owner of The Hazlett Group in St. Louis, Mo. Often the pulmonologist also performs washings, which involve the pulmonologist suctioning small amounts of saline or aliquots through the patient's airways. Check the physician documentation for details about the surgical approach and the bronchoscopy's purpose to determine if 31622 is the correct code to report.

Example: A surgeon calls your pulmonologist in for an urgent consultation about a patient who underwent heart surgery and is having difficulty breathing during recovery. After your physician examines the patient and reviews x-rays, he decides to perform a diagnostic bronchoscopy. Report the urgent consultation using 99251-99255 (Initial inpatient consultation for a new or established patient ...) based on the level of service noted in your physician's documentation. For the diagnostic bronchoscopy, report 31622.
 
Be sure to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service code to indicate that your physician performed the separately identifiable consult in addition to the bronchoscopy.

Caution: The National Correct Coding Initiative bundles 31622 into all other bronchoscopy procedures, such as 31625 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy[s], single or multiple sites) and 31628 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy[s], single lobe). If one of the more comprehensive codes best represents the procedure your pulmonologist performs, be sure to report that code, not 31622.

Report 31624 for BAL procedures

When your physician's documentation specifies that he performed a bronchoalveolar lavage (BAL), you should report 31624. "This is what is known as a liquid biopsy of the distal airways and alveoli," O'Neil says. Physicians often use this procedure to help them diagnose certain types of cancers, infections or lung disease.

"This code involves a more complicated input/output measurement and sampling than the 'wash' code does," Young says. A BAL allows the pulmonologist to sample lung tissue by irrigating with saline and then suctioning the fluid. Typically, the physician wedges the bronchoscope into an area and administers saline in 20- to 30-ml aliquots into that area. Then, the pulmonologist must aspirate the saline into a sterile syringe or trap after each aliquot, and send the containers for analysis.

Example: A patient presents to your practice with cough, sputum and fever. An x-ray shows a right-lower lobe infiltrate. Your pulmonologist performs a bronchoscopy. The documentation states that during the bronchoscopy the physician "instilled 100 ml of saline into the patient's right lower lobe, and the operator received a return of 35 ml of fluid." This means that the pulmonologist completed a BAL and you should report 31624.

Be aware: A BAL procedure is not the same as a whole-lung lavage, O'Neil says. A patient undergoes a whole-lung lavage while under general anesthesia, and the physician performs a total lavage of one lung using alternating infusion and drainage of a balanced salt solution. You should report this procedure using 32997 (Total lung lavage [unilateral]).