Wiki Bronchoscopy 31622 can this be used for a difficult airway during a Cholecystectomy?

Tammy R

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My doctor has said he did a bronchoscopy for a difficult airway during a cholecystectomy is the 31622 the correct code to bill? Thank you for your help!
A bronchoscopy 31622 is a diagnostic procedure of the respiratory system. This does not sound correct if the physician is performing a cholecystectomy. Perhaps the physician was assisting the anesthesiologist to intubate the patient? Placement of the airway is a component of anesthesia services so it would not warrant billing a separate procedure. It's hard to advise on the coding though without seeing the procedure note to know what was actually done.
Copy of op report

This is a copy of the op report for the cholecystectomy and the bronchoscopy.

PREOPERATIVE DIAGNOSIS: Acalculous cholecystitis.

1. Acalculous cholecystitis.
2. Difficult airway.

1. Flexible bronchoscopy with placement of airway.
2. Laparoscopic cholecystectomy with an intraoperative cholangiogram.


ANESTHESIA: General endotracheal.

OPERATIVE PROCEDURE: After satisfactory IV sedation was obtained, anesthesia attempted to put an airway in using a video laryngoscope. The vocal cords were easily visualized, however, the patient’s neck angle was extremely tight, and even with adjustable instruments, they were not able to safely place the airway. Therefore, the patient was allowed to awaken. With him awake, I placed a bronchoscope in the right naris, advanced it to the carina, and over the bronchoscope slid a #7 nasotracheal tube. The cuff was insufflated and excellent oxygenation was achieved.

Once general anesthesia was achieved, the patient’s abdomen was prepped and draped in the usual fashion. A Visi-Port was introduced in the right upper quadrant, and under direct visualization, a 5 mm port was placed at the umbilicus. 2 mm ports were introduced in the right upper quadrant. The cystic duct was dissected out and a negative intraoperative cholangiogram was obtained. The cystic duct and cystic artery were doubly hemoclipped and divided. The gallbladder was dissected from the gallbladder fossa with electrocautery dissection and removed through the subxiphoid position. The subxiphoid fascia was closed with 2-0 PDS sutures. All air and all instruments were then removed. The wounds were injected with Marcaine and the incisions were closed with 4-0 Prolene. The patient tolerated the procedure well
The documentation indicates that this is an intubation using a bronchoscope, not a diagnostic bronchoscopy. It wouldn't be appropriate to report this with a separate code. Here is the guidance from the NCCI manual, Chapter I, General Correct Coding Policies:

"Many invasive procedures require vascular and/or airway access. The work associated with obtaining the required access is included in the pre-procedure or intra-procedure work.... Airway access is necessary for general anesthesia and is not separately reportable.... Visualization of the airway is a component part of an endotracheal intubation, and CPT codes describing procedures that visualize the airway (e.g., nasal endoscopy, laryngoscopy, bronchoscopy) should not be reported with an endotracheal intubation. These CPT codes describe diagnostic and therapeutic endoscopies, and it is a misuse of these codes to report visualization of the airway for endotracheal intubation."