Learn 3 Different Options to Fix a 31624/31652 Denial
Question: I have a question about a denial we received. The pulmonologist performed a bronchoalveolar lavage at the right middle lobe, so we reported 31624. They also performed an endobronchial ultrasound (EBUS) to examine multiple stations and did a fine needle aspiration (FNA) on the lymph node at station seven. CPT® code 31652 was reported for this procedure. We reported R59.0 and R91.8 as the diagnosis codes for enlarged lymph nodes and abnormal diagnostic imaging, respectively. The pathology was negative. CPT® code 31652 was denied. How can we fix the claim? New York Subscriber Answer: Your coding situation can be resolved in a handful of ways, let’s see how. Option 1: CPT® codes 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) and 31652 (… 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) are the correct procedure codes to report in your situation, and the codes aren’t listed in the National Correct Coding Initiative (NCCI) procedure-to-procedure edit pairs. This means the codes can be reported separately when the provider performs the procedures. However, you might need to append modifier 51 (Multiple procedures) to 31652 to indicate to the payer that 31652 was an additional procedure that took place on the same date of service. According to chapter 5 of the Medicare NCCI Policy Manual, “When endoscopic service(s) are performed, the most comprehensive code describing the service(s) rendered shall be reported. If multiple services are performed and are not adequately described by a single CPT code, more than one code may be reported. The multiple procedure modifier 51 should be appended to the secondary service CPT® code(s).” Option 2: You state you reported R59.0 (Localized enlarged lymph nodes) for the enlarged lymph nodes and R91.8 (Other nonspecific abnormal finding of lung field), but these might not be the correct codes for the procedures. You may need to revise the ICD-10-CM code selections based on the medical record, as the codes may not be accepted by your payer to show medical necessity for the procedures. Review the pulmonologist’s documentation to verify the diagnoses and then assign the correct ICD-10-CM codes. Option 3: Contact the payer to confirm their preferences for reporting the procedures and diagnoses. They might have witnessed situations such as yours before and have standard reporting procedures for those instances. It never hurts to double-check with the payer, government or commercial, to make sure everyone is on the same page. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
