Pulmonology Coding Alert

Question: How do I code an extended bronchoscopy with several endobronchial biopsies (bx), brushing (two times), and washings (four times) and needle aspiration performed all at the same time?

Georgia Subscriber

Answer: A bronchoscopy with endobronchial bx, transbronchial needle aspiration biopsy, brushing and washings performed all at the same time should be coded as follows: 31625 (bronchoscopy, [rigid or flexible]; with biopsy); 31629-59 (bronchoscopy, [rigid or flexible]; with transbronchial needle aspiration biopsy) (distinct procedural service), modifier -59 indicates that this biopsy was on a different lesion than the one(s) included in code 31625; and 31623-51 (bronchoscopy, [rigid or flexible]; with brushing or protected brushings) (multiple procedures).

If due to unusual circumstances the procedure required significantly more physician work than would normally be expected, and the documentation clearly reflected this additional work, modifier -22 (unusual procedural services) could be reported with any of the codes.

CPT code 31623 would not be reported more than once despite the number of brushings performed. The biopsy is reported with 31625, and would only be reported once. The washings are bundled into the other procedures and not billed separately.