Correctly Report Bronchoscopy Procedures With Multiple Sampling Techniques
Remember to sequence your codes by RVU value. Bronchoscopy procedures are quite common for pulmonology coders to come across in their workflow, but how familiar are you with coding multiple techniques in a report? “A bronchoscopist physician typically performs multiple sampling techniques in a single operative session. My providers want to bill it out. They do a lot of sampling,” said Oby Egbunike, CCS-P, CPC, COC, CRC, AAPC Approved Instructor, director of professional coding for Beth Israel Lahey Health Care System, during her HEALTHCON 2025 session. Read on to learn how to report multiple samplings via bronchoscopy procedures. Refresh Your Understanding of Billing Multiple Bronchoscopies Before getting started, here’s a quick refresher on abbreviations of common bronchoscopy procedures: “When multiple sampling techniques are performed, only one CPT® code, considered as the primary code, is reimbursed at 100 percent, while the rest of the codes are reimbursed partially,” Egbunike explained. The partial reimbursements are based on the rates established by the Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule (MPFS). For example, if you have a report where the pulmonologist performed three separate procedures, they can expect reimbursement amounts as follows: At the same time, add-on codes are reimbursed at 100 percent on top of the primary and secondary codes. If the pulmonologist performs a flexible bronchoscopy with cell washing and a bronchoscopy with EBUS to remove peripheral lesions, then both of the codes below would be reimbursed at 100 percent: “While an in-depth knowledge of bronchoscopy coding is pertinent, if you use an electronic medical record [EMR] system that doesn’t arrange your codes properly before they post, you're in trouble. But if you use an EMR system that does arrange it based on relative value unit [RVU] values for you, you don’t have any problems,” Egbunike said. If your EMR system doesn’t automatically arrange the codes according to RVU value, you’ll need to confirm which code has the highest RVU value and place it as the primary procedure code. You’ll then place the next highest RVU value code in the secondary procedure slot, and so on. Report Brushing and BAL Together Example: The provider performed cytology brushing during a bronchoscopy. The physician advanced the scope to the desired location needed for the BAL. Provider performed BAL in the right middle lobe and obtained a lung tissue sample for analysis and cytology. In this example, the pulmonologist performed a bronchoscopy with cytology brushing and BAL. You’ll assign 31623 (… with brushing or protected brushings) to report the brushing and assign 31624 (… with bronchial alveolar lavage) for the BAL. Examine This EBBX and Radial US Case Example: The physician performed EBBX in the left main stem of the bronchus. Radial ultrasound (US) imaging was used during the procedure. The provider obtained the tissue using forceps, and the sample was sent to histopathology for testing. “In this procedure the provider removed a small sample of the longer airway tissue for testing, and the brachial biopsy were performed in the left main stem,” Egbunike said. Assign 31625 (… with bronchial or endobronchial biopsy(s), single or multiple sites) to report the EBBX procedure. The provider also used radial US imaging, so you’ll use +31654 as the secondary procedure code. There may be times when the physician uses robotic navigation for the procedure. In those cases, you’ll use +31627 (… with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s])) in addition to the primary CPT® code. Tackle This Complex Multiple Pulmonary Nodules Situation Example: The patient presents to the pulmonologist for a bronchoscopy procedure. The indication for the procedure is multiple pulmonary nodules. The bronchoscope was passed under direct vision. Robotic navigation was used during the bronchoscopy. The physician found several bilateral nodules and then began the navigation phase to locate the target lesions. Using fluoroscopy and radial US, provider confirmed positioning and lesion. The largest nodule was located in the posterior segment of the right upper lobe (RUL). The provider performed seven passes via cryobiopsy and three passes via TBXX. The physician then advanced the scope to the RUL posterior segment where BAL was performed. The sample obtained was sent for testing. The provider also performed EBBX on a lesion in the bronchus intermedius. Three samples were obtained using forceps and sent for examination. In this scenario, the pulmonologist performed it all. They did bronchoscopy robotic navigation, radial EBUS, BAL, EBBX, TBNA, and TBBX. In total, five CPT® codes are required to report this surgical encounter. Assign 31628 (… with transbronchial lung biopsy(s), single lobe) to report the multiple cryobiopsy and TBXX biopsies in the RUL. You’ll use 31624 for the BAL in the RUL posterior segment. Assign 31625 for the EBBX in the bronchus intermedius. Lastly, you’ll assign add-on codes +31627 and +31654 for the robotic navigation and radial US, respectively. Next, the trick is placing the procedure codes in the correct RVU value order. Below is the sequencing of the codes for this encounter: Remember: “If you have an EMR that can arrange it properly for you, it’s okay. If you don’t have the proper EMR, please remember the first base code pays at 100 percent, the second code at 75 percent, third code at 50 percent, except if it’s an add-on code,” Egbunike reminded. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
