Pulmonology Coding Alert

Question: One of our thoracic surgeons performed a diagnostic bronchoscopy. Based on the results of the bronchoscopy, he performed thoracic surgery. Can I report both the bronchoscopy and the thoracotomy?


New York Subscriber


Answer: Because the thoracic surgeon performed a diagnostic bronchoscopy during which he discovered a problem requiring surgery, you can report both procedures. If the same physician performs both services on the same day, use 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]) for the bronchoscopy and 32100 (Thoracotomy, major; with exploration and biopsy) for the surgical procedure.

Don't forget: Check your National Correct Coding Initiative edits before you report bronchoscopy and thoracotomy codes together. NCCI bundles 32100 and 31622. To overcome these bundling edits, append modifier 59 (Distinct procedural service) to the bronchoscopy code, if appropriate. The modifier indicates to your payers that the bronchoscopy was a completely separate procedure.
 
Caution: If the physician performs an endoscopy incidental to a second procedure, you should not report the endoscopic procedure separate from the surgery.

For example, if your thoracic surgeon performs a tracheoscopy solely to determine if an endotracheal tube is in the correct position before surgery, you should not report 31525 (Laryngoscopy, direct, with or without tracheoscopy; diagnostic, except newborn) in addition to 31600 (Tracheostomy, planned [separate procedure]) because the tracheoscopy is incidental to the major tracheostomy surgery.