Pulmonology Coding Alert

Question: An established patient visited our pulmonologist at the office for shortness of breath and chest tightness. The physician spent 25 minutes during the E/M with moderate MDM (level 4), then performed a flexible diagnostic bronchoscopy. The pulmonologist then brought the patient back after two weeks for another bronchoscopy with brushing. How should I code the scenarios? 

Washington Subscriber

Answer: You should report the first encounter with:

• 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity) for the E/M visit.

• 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]) for the diagnostic bronchoscopy.

Don’t forget to attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to 99214 to show that the E/M and bronchoscopy were separate services.

When reporting multiple bronchoscopies, the most crucial point of consideration is “date of service.” You cannot report two procedure codes if the physician performs both the diagnostic and interventional bronchoscopies on the same date, even if the physician conducts them during separate sessions with the patient. In these scenarios, the Correct Coding Initiative (CCI) bundles the diagnostic bronchoscopy (31622) into other bronchoscopies, without the ability to unbundle the services. However, in your case, because the bronchoscopies occurred on different dates, you can report them separately.

On the claim for the second encounter, you can report 31623 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings). Make sure to clearly document the date the pulmonologist performed the second bronchoscopy.