Bronchoscopy

ssprinkle

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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.
 

Lujanwj

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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.
 

ssprinkle

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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?
 

Lujanwj

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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.
 
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