Pulmonology Coding Alert

Question: How do I code a bronchoscopy with endobronchial biopsy, needle aspiration, brushing and washings performed all at the same time?

Idaho Subscriber

Answer: A bronchoscopy with endobronchial biopsy, transbronchial needle aspiration biopsy, and brushing and washings performed all at the same time would be coded as follows:

31625-59 bronchoscopy with biopsy; (modifier -59, distinct procedural service, indicates a different site from the needle biopsy, otherwise it is bundled)

31623-51 bronchoscopy with brushings; multiple procedures

31629-51 bronchoscopy with transbronchial needle aspiration biopsy; multiple procedures

HCFAs Correct Coding Initiative bundles payment for 31625 into 31629 and prevents the code pair from being billed on the same date of service. Under certain circumstances, it is appropriate and permitted to unbundle. An example is when a biopsy (31625) is performed on a separate lesion or at a location of the lung that differs from the transbronchial needle aspiration biopsy, and modifier -59 should be appended to 31625.

Modifier -51 indicates the performance of multiple procedures on a particular date of service. Typically, payment for multiple procedures occurs on a percentage basis: 100 percent of the Medicare Allowable Payment (under the Physician Fee Schedule) for the first, 50 percent for the subsequent procedure. Since bronchoscopies are reimbursed under the Multiple Endoscopy Payment Guidelines, it may not be necessary to append modifier -51. Ask your local Medicare carrier for its requirements.