Pulmonology Coding Alert

Question: I have a procedure note in which the pulmonologist wrote that during a bronchoscopy the physician discovered mucopurulent, brownish material in all airways. The note adds the material was “removed with suction and lavage, and the samples were sent to pathology.”

Should we report 31622 or 31624 for this encounter?

Montana Subscriber

Answer: Both 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)) and 31624 (… with bronchial alveolar lavage) are very similar in their code descriptors, which means you’ll need to review the documentation further before determining which code to select.

Cell washing — performed under 31622 — is considered a simple process and requires a small amount of saline to wash the suspicious cells before the provider obtains a sample for testing. On the other hand, 31624 includes bronchoalveolar lavage. This part of the procedure typically uses a larger amount of saline when compared to the saline amount used for cell washing.

Using your scenario as an example, you might see details such as “infused 60 ml of saline and removed 20 ml of fluid by suction.” Additionally, bronchoalveolar lavage may require multiple saline instillations during the procedure.

If the provider’s documentation lists cell washing and indicates a small amount of saline, then you’ll assign 31622. However, if the documentation indicates bronchial alveolar lavage, calls out a large amount of saline, and indicates the provider performed multiple instillations, then you’ll assign 31624.