Wiki Bronchoscopy and Thoracoscopy (31622 and 32666)

[ljones88]

Hi all,
I need help as I'm new to thoracic.

Dr performed 31622 prior to 32666. 32666 was planned so it wasn't like the dr did 31622 and then decided to perform 32666.

We billed 31622 and 32666. Aetna denied 31622 as inclusive. I understand NCCI states, "A diagnostic endoscopy is not separately reportable with a surgical endoscopy per CPT Manual instructions." I understand that to mean if any type of diagnostic endoscopy procedure is performed during the same session as a surgical endoscopy procedure, the diagnostic scope is not reported UNLESS two different scopes are used to assess separate issues.

I don't believe we should have billed 31622 in this case. Op note attached for reference. However, coworkers believe that because 2 separate scopes were used on different anatomic sites both scopes are reportable.

So I guess my question is this: Do we have grounds to bill both codes? What is the medical necessity of performing 31622 prior to 32666 other than to confirm the surgical field and confirm no other lesions were noted?

Thank you!

 

[MiMimed]

Hi all,
I need help as I'm new to thoracic.

Dr performed 31622 prior to 32666. 32666 was planned so it wasn't like the dr did 31622 and then decided to perform 32666.

We billed 31622 and 32666. Aetna denied 31622 as inclusive. I understand NCCI states, "A diagnostic endoscopy is not separately reportable with a surgical endoscopy per CPT Manual instructions." I understand that to mean if any type of diagnostic endoscopy procedure is performed during the same session as a surgical endoscopy procedure, the diagnostic scope is not reported UNLESS two different scopes are used to assess separate issues.

I don't believe we should have billed 31622 in this case. Op note attached for reference. However, coworkers believe that because 2 separate scopes were used on different anatomic sites both scopes are reportable.

So I guess my question is this: Do we have grounds to bill both codes? What is the medical necessity of performing 31622 prior to 32666 other than to confirm the surgical field and confirm no other lesions were noted?

Thank you!

View attachment 3000

I have been coding thoracic for over 6 years and our surgeons always do a bronchoscopy before any major lung surgery. Not only is it to confirm no other lesions, it's also to make sure there is no evidence of endobronchial obstructions or masses. We bill 31622 with modifier -59 as it is a separate procedure during the surgery. Hope this helps.
Yvonne

 

[CodingKing]

I have been coding thoracic for over 6 years and our surgeons always do a bronchoscopy before any major lung surgery. Not only is it to confirm no other lesions, it's also to make sure there is no evidence of endobronchial obstructions or masses. We bill 31622 with modifier -59 as it is a separate procedure during the surgery. Hope this helps.
Yvonne

Always performed is typically an indicator of a bundled procedure.

When a diagnostic or surgical endoscopy of the respiratory system is performed, it is a standard of practice to evaluate the access regions. A separate HCPCS/CPT code should not be reported for this evaluation of the access regions.

While i'm not an expert in this area, looking to see if there are any "endobronchial obstructions or masses" sounds like an evaluation of access regions. What is the purpose of looking for it? Is it something to see if an obstruction would necessitate an open procedure instead?

Here is an example of when you can

If medically reasonable and necessary endoscopic procedures are performed on two regions of the respiratory system with different types of endoscopes, both procedures may be separately reportable. For example, if a patient requires diagnostic bronchoscopy for a lung mass with a fiberoptic bronchoscope and a separate laryngoscopy for a laryngeal mass with a fiberoptic laryngoscope at the same patient encounter, HCPCS/CPT codes for both procedures may be reported separately. It must be medically reasonable and necessary to utilize two separate endoscopes to report both codes.

 

[lisigirl]

I have always considered the bronchoscopy prior to a chest procedure to be included. As Yvonne said, the surgeons are most often performing this to get a "lay of the land" before proceeding with the primary procedure. The Society of Thoracic Surgeons advises that you do not bill a diagnostic bronchoscopy (31622) with the surgical procedure unless it is clear that the surgeon has not already done one previously.

Lisi
eharkler@nm.org