Pulmonology Coding Alert

Question: A pulmonologist performed electrocautery resection of endobronchial tumor, had an hour of critical care (cc), and bronchoscopy and wash. What codes should I report that describe these procedures? Massachusetts Subscriber Answer: You may use 31641 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with destruction...) to represent the tumor resection since it describes tumor destruction by any method other than excision. Meanwhile, the bronchoscopy and wash may represent cell washings or a bronchial alveolar lavage (BAL) -- depending on the extent of the "washing." The September 2004 CPT Assistant describes BAL as involving repeated instillations of sterile saline occurring in aliquots with aspiration into one or more containers. The procedure involves a physician putting large amounts of saline (20- 30 ccs per instillation) into the airway and suctioning the secretions into a container which he then sends to the microbiology and pathology laboratories for analysis. Careful: This is not [...]