Pulmonology Coding Alert

Question: We've been using 31629 and 31633 to code for multiple lymph node biopsies performed during bron-choscopy in our office, but I recently heard that these are not the correct codes to use. Can you shed some light?New York SubscriberAnswer: You have been using the correct codes assuming the samples came from different sites. Use 31629 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial needle aspiration biopsy[s], trachea, main stem and/or lobar bronchus[i]) to code for the first group of lymph nodes sampled. Use 31633 (... with transbronchial needle aspiration biopsy[s], each additional lobe [List separately in addition to code for primary procedure]) when lymph nodes are sampled from a different lobe. If lymph nodes are sampled from more than one mediastinal site, this constitutes a single area and you can only code for a single site. If lymph nodes are sampled from the lobar bronchus and subcarinal or hilar sites, then the add-on code, 31633, can be used. However, if you use endobronchial ultrasound (EBUS) you should use a separate add-on code for the EBUS (31620).Example: If the pulmonologist used EBUS to perform transbronchial needle aspirations of lymph nodes located on the right and left sides of the trachea, and sampled lymph nodes in the right hilar areas, you should code 31629 once for the transbronchial needle aspirations of the lymph nodes from both tracheal sites, 31633 for the trans-bronchial needle aspirations from the right hilum, and 31620 for the EBUS.