Pulmonology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: The pulmonologist at our practice performed a bronchoscopy on a patient. He did multiple biopsies of the right-upper lobe and the right-middle lobe. I am using code 31625. It does not state if this code is for one biopsy area or if it can be used multiple times (different areas) with modifier -59. Texas Subscriber

Answer: Reporting multiple biopsies depends on whether or not they are taken via different methods. In this case, you should report the most appropriate codes: 31625 (Bronchoscopy [rigid or flexible]; with biopsy), 31628 (... with transbronchial lung biopsy, with or without fluoroscopic guidance), or 31629 (... with transbronchial needle aspiration biopsy). Following Medicare's multiple-endoscopy rule, you should add modifier -51 (Multiple procedures) to any additional endoscopies performed that have the same base code as the primary procedure. Most biopsy procedures performed by the same method, however, are reportable only once despite the number of biopsies taken.

You said that you use 31625, so I will assume both biopsies are by the same method. You should code the following:
31625. If they were taken by different methods, you would code the scenario as follows:
31628
31625-59-51. Modifier -59 (Distinct procedural service) indicates to the payer that the pulmonologist took the second biopsy from a separate site. Your payer may still deny the claim because pending review of the documentation, the payer, if not Medicare, may not recognize modifier -59. In this case, you can appeal with a copy of the report. Many private carriers will not reimburse a single provider for more than one endoscopy procedure on the same date.