Pulmonology Coding Alert

Question: Our pulmonologist performed a bronchoscopy with left upper and lower lobe endobronchial biopsies, left lower lobe transbronchial biopsy, left upper lobe brushing, left upper and lower lobe washing. How should I code these procedures?

Oregon Subscriber

Answer: The correct CPT® code for bronchoscopy for the left upper and lower lobe endobronchial biopsies is 31625 regardless of the number of biopsies taken. The left lower lobe transbronchial biopsy is 31628 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe). As per CPT® rules, you can bill 31628 only once per lobe even if physicians biopsied multiple bronchial sites within a given lobe. The brushings are reported with 31623.

According to the National Correct Coding Initiative (CCI), you can code 31625 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy[s], single or multiple sites) only for multiple bronchial biopsies taken from lobes different from any other biopsy method, and you may report this code only once per session.

Modifier 51 also does not apply to reporting multiple bronchoscopy procedures, as bronchoscopies are governed by the multiple endoscopy rule.

In this case, the pulmonologist has performs a bronchial biopsy (31625) during the same bronchoscopy session in a different lobe than a transbronchial lung biopsy (31628), and you will report the bronchial biopsy with modifier 59 along with the brushings (31628, 31625-59, 31623).

Remember: Coder may report bronchial or endobronchial biopsies (31625) only once per session, regardless of the number or sites of biopsy.

Your question indicated the performance of left upper lobe washing and left lower lobe washing. If the operative report indicates washings, they cannot be billed separately and are part of the code 31628. Although a separate procedure, washings are part of bronchoscopy code 31622 (Bronchoscopy, [rigid or flexible]; including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]) and cannot be billed more than once.

Review the operative report to determine if the bronchoscopy with biopsies was performed in the left lung, upper and lower lobes. If so, you should not bill the procedure twice just because the physician performed it on two different anatomic sites. If the physician performed the bronchoscopy with bronchial alveolar lavage and the documentation demonstrates the details associated with this more extensive procedure, report 31624 instead of 31623.