Pulmonology Coding Alert

Question: Our pulmonologist recently performed a bronchoscopy with BAL on a morbidly obese patient. But the bronchoscopy was lengthened due to altered anatomical features and made the service more difficult and also required more than the usual time to complete. How should I report this scenario for better reimbursement?

North Dakota Subscriber

Answer:  You should report the bronchoscopy with broncho alveolar lavage (BAL) with 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage). You should then attach modifier 22 (Increased procedural services) to the bronchoscopy procedure code.

Although you can consider the use of modifier 22 in scenarios such as unusual body habitus (obesity, unusually thin, tall, short, etc.), altered anatomy (congenital or due to trauma or previous surgery), and very extensive injury or disease, you should not automatically opt for it before ensuring extensive documentation to back it up. You’ll only be able to append modifier 22 when a procedure requires substantially greater additional time or effort because of the patient’s obesity. The description of the procedure needs to match the modifier 22 statement.

Because your physician provided a greater service than is stipulated in the code description, on your claim you should indicate the fee that you expect to be reimbursed from the carrier, along with the percentage of time the procedure extended beyond the usual time allotted for that procedure. For example, if you physician devoted 25 percent more time/effort for the procedure, you should increase the fee (25 percent) in accordance with the additional effort.

To support appending the modifier, your pulmonologist should document how the patient’s obesity increased the complexity of that particular case. You can do it by presenting a comparative analysis of your pulmonologist’s actual time, effort, or circumstances devoted to the BAL procedure against the usual time and effort required for that procedure. It would be advisable document clearly in the medical records the reason(s) for the increased effort and time spent.