Pulmonology Coding Alert
Exhaust All Alternate Codes Before Reporting Base Bronchoscopy
Question: We have a case where the bronchoscopy dictation states, “copious amounts of mucopurulent, brownish material noted in all airways. These were removed with suction and lavage, and samples were sent to lab for routine studies.” Should I code this as 31622?
Washington Subscriber
Answer: No. According to National Correct Coding Initiative (CCI), you need to avoid 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]) if there is any other code that better determines the procedure your pulmonologist has performed. This means that you should not use 31622 when other bronchoscopy procedures such as bronchoalveolar lavage are done. According to your description, the procedure may be nearer to 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) than 31622.
You have to go through the procedure notes in detail. If your pulmonologist has performed a bronchoalveolar lavage, you will see the procedure notes carrying details such as “infusion of saline” and “suction of fluid.” This will confirm the procedure as 31624. Your physician may have performed a bronchoalveolar lavage with a diagnostic intent, though sometimes it may be done as a treatment for the underlying condition.
Bronchoalveolar lavage is different in comparison to a cell washing procedure reported by 31622. A bronchoalveolar lavage implies the instillation of “larger” quantities of saline than for a “simple” bronchial washing, often done as part of a diagnostic bronchoscopy to evaluate for malignancy in which a biopsy, bronchial brushings and washings are collected. The bronchoalveolar lavage is often done in patients with unexplained infiltrates in which an opportunistic infection is a part of the differential diagnosis.
Note: In order to support 31624 over 31622, ensure that the physician identifies the total amounts instilled and returned during the procedure. Without these specific details, the documentation may only support and be reimbursed for the “simple” washing, 31622.
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