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Answer: The correct code for bronchoscopy with left upper lobe and left lower lobe end bronchial biopsies and left lower lobe transbronchial biopsy is 31628 (broncho-scopy [rigid or flexible]; with transbronchial lung biopsy, with or without fluoroscopic guidance). Code 31628 can be billed only one time even though multiple bronchial sites were biopsied.
CPT 2001 states, For endoscopic procedures, code appropriate endoscopy of each anatomic site examined. In this case, a different anatomical site doesnt necessarily indicate opposite sides of the lungs. In clinical practice, each of the five lobes is considered a different anatomical site. Therefore, although the procedure was performed in the same lung, it was performed at different anatomical sites in the lung.
According to the Correct Coding Initiative (CCI), 31625 (bronchoscopy [rigid or flexible]; with biopsy) is a component code of 31628 and cannot be reported separately because this would be unbundling. Because biopsies were reported for different anatomical sites of the lung (left upper lobe and left lower lobe), however, you may bill 31625 with a -59 modifier (distinct procedural service) in addition to the transbronchial lung biopsy (31628).
Regarding the left upper lobe washing and left lower lobe washing, if the operative report indicates washing, they cannot be billed separately. They are part of the 31628. Although a separate procedure, washing is part of bronchoscopy code 31622 (bronchoscopy [rigid or flexible]; diagnostic, with or without cell washing [separate procedure]) and cannot be billed more than once.
Review the operative report to determine if the bronchoscopy with biopsies was performed in the left lung, upper and lower lobes. If so, note that the procedure should not be billed twice just because it was performed on two different anatomic sites. If the bronchoscopy was performed with bronchial alveolar lavage, however, report 31624 with modifier -51 (multiple procedures) as multiple procedures to 31628.
For the left upper lobe brushing, the correct code is 31623 (bronchoscopy [rigid or flexible]; with brushing or protected brushings). Because this was a secondary procedure (to the 31628), it would be billed with modifier -51 to indicate multiple procedures.
Answer provided by Catherine Brink, CMM, CPC, principal of Healthcare Resource Management Inc., a healthcare consulting firm specializing in medical manage-ment, coding and reimbursement in Spring Lake, N.J.
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