Pulmonology Coding Alert

Question: Our pulmonologist recently performed a bronchoscopy with brushing and washings and also performed an endobronchial biopsy along with transbronchial needle aspiration biopsy in the same procedure. What is the right way to report the procedures that our pulmonologist performed?

Oregon Subscriber

Answer: The right way to code will depend on the site/ sites in which the procedures were conducted. If your pulmonologist was performing the two biopsy methods on the same lesion, then you can only report the transbronchial needle aspiration biopsy (TBNA) with 31629 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) and the brushings with 31623 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings).

In this scenario, if the endobronchial biopsy were performed on a lesion with a TBNA performed on a node, you may report with 31625 and 31629. Correct Coding Initiative bundles 31625 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy[s], single or multiple sites) into 31629 and can only be reported separately by appending modifier 59 when appropriate (as in this case). Washings are included in the base procedure and not separately reported.

The first procedure you need to report would be 31629 as it the more comprehensive procedure and will be reimbursed at 100 percent of the Medicare Allowable Payment (Under the Physician Fee Schedule). The other two procedures should be reported after that and will be paid as per the criteria indicated in the Multiple Endoscopy Payment Guidelines. As per these guidelines, it is not necessary to append modifier 51 (Multiple procedures) to the other two codes to claim reimbursements for these two procedures.