Pulmonology Coding Alert

Question: Our pulmonologist completed a bronchoscopy with protected brushings and cytology in two lobes. He also performed alveolar lavage in two lobes and a single bronchial biopsy. What is the correct way to code this procedure?Virginia SubscriberAnswer: For the protected brushing, submit 31623 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with brushing or protected brushings). All brushings (single or multiple lobes) are included in this code, so only report it once.Next, report the lavage with 31624 (... with bronchial alveolar lavage). Check with your carrier before coding this part of the procedure, because you'll find variations in protocol. Medicare, for example, allows reporting this code once, regardless of how many lobes the pulmonologist lavaged; some other payers might accept multiple codes.Modifier preference: The same holds true for modifiers; check your payer's guidelines. When you report two 31624s, some payers accept modifier 59 (Distinct procedural service) for the second location, but other payers want modifier 51 (Multiple procedures).Complete your claim with 31625 (... with bronchial or endobronchial biopsy[s], single or multiple sites) for the bronchial biopsy.