Wiki Bronchoscopy


Keosauqua, IA
Best answers
When Dr. performs Bronch. on Lt & Rt, How would you bill this? This question keeps coming up with the codes in section 31622-31656. I realize some of these have codes for the single lobe and addtl lobes. Those I get..... But what about 31622 done on both sides? and 31625 done on Lt & Rt.? How would you bill those? Any and all comments appreciated. PLEASE HELP.......

Thanks in advance.
Per CMS, modifier -50 is not allowed and MUE's of 1 would indicate that CMS believes the codes to be Bilateral in nature. I could be wrong but the standard of care would be to check/DX both sides to be sure you aren't missing anything.

CPT Assistant 9/08 says: CPT code 31622 describes basic diagnostic bronchoscopy. It is used to describe a procedure that involves the use of a bronchoscope with visualization of all major lobar and segmental bronchi. The physician inserts the bronchoscope through the upper airways noting any abnormalities. The vocal cords are visualized and the structure and function are noted. The bronchoscope is advanced into the tracheobronchial tree. All of the airways are inspected. It may also include the obtaining of diagnostic specimens as part of the examination.
Thank you, I do see that these cannot be billed as Bilateral with -50. but the Dr is questioning if can bill 31625 and 31625-59? Or 31624 and 31624-59? since this is done in both sides?
I'd suggest going to CMS.Gov and downloading the NCCI Edits, Medically Unlikely Edits and PFS Relative Value Files. That data will arm you with most of what you'll need to back your argument to your Dr.

PFS RV File: Bilateral Surgery = 0

MUE:1 Would be "2" if both sides were allowed

NCCI Edits: 31625 31622 = 0 Zero means modifier not allow and you could never justify modifier -59 to by-pass the edit. If it was "1", it would mean you can do a DX on RT and Lavage on LT and to justify -59 to by-pass the edit.

All of this data indicates that these are bilateral procedures.
Procedure(s): Flexible bronchoscopy, right minimally invasive thoracotomy, decortication, pleural biopsy, mechanical and chemical pleurodesis, Pleurx catheter insertion, intercostal nerve blocks 2 through 8 on the right.

Anesthesia: General endotrachial anesthesia

Indications: See pre-operative history and physical.

Findings: Chronically trapped right lung with thickened pleura and recurrent effusion.

Specimen(s): Pleural fluid for cytology and culture. Empyema rind for pathology and culture. Pleura for pathology and culture.

Estimated Blood Loss: Less Than 100ml

Other: Implants: 32 French chest tubes. Pleurx catheter.

Complications: None.

Description of Procedure: After intubation a flexible bronchoscope was passed down the endotracheal tube. The airways were inspected from the trachea to the lobar bronchi bilaterally. There were no endobronchial lesions found. Patient was placed in the left lateral decubitus position and prepped and draped sterilely. A 3-1/2 inch vertical midaxillary minimally invasive thoracotomy incision was made over ribs 3 through 5. Electrocauterization was used to dissect down in between the leaves of serratus enter the fourth interspace. Large amount of recurrent pleural effusion that was amber-colored was found and evacuated. This was sent for cytology and culture. Retractors were placed. Lung was chronically trapped in the superior and mid aspect. There was chronic empyema that was decorticated. Empyema rind was sent for pathology and culture. Lung was decorticated as much as possible without causing damage. Pleura was noted to be thickened and pleural biopsy was performed sharply. The specimen was sent for pathology and culture. Right hemithorax was irrigated copiously with antibiotic irrigation. 2 stab incisions were made 32 French straight and right angle chest was replaced in the anterior apical and posterior lateral positions. These were secured with Ethibond suture. Stab incision was made in the right upper quadrant and in the right chest wall. PleurX catheter was tunneled from the right upper quadrant to the chest wall incision and then tunneled into the pleural space. This was secured to the skin with silk suture. Serratus was reapproximated in 1 Vicryl pericostal suture running fashion. Wound was irrigated vancomycin irrigation. Fashion deep tissue closed with 2 layers of #1 Vicryl suture. Skin was closed with a running 4-0 Monocryl suture. Intercostal nerve blocks 2 through 8 were performed on the right with 20 cc of quarter percent Marcaine without epinephrine. Patient was transported to the PACU in stable condition.

Condition: Stable