Need help with coding

hostetlp

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I relatively new to coding cardiothoracic and vascular surgery. I am not sure if I am selecting the correct code. My confusion is when do you use 31654 EBUS during therapeutic/diagnostic bronchoscopy. Any help will be much appreciated. Thank you Patti

I think coding should be:
31653 ebus 3+ samples
31645 bronscpy with aspiration
32554 thoracentesis


· Procedure: After appropriate monitoring lines had been placed, anesthesia was induced and a single lumen tube was placed. A full timeout was performed where the correct patient and procedure to be performed were identified. A flexible bronchoscope was inserted into the trachea and the tracheobronchial tree was inspected. Inspection revealed a normal trachebronchial tree with no endoluminal lesions. The prior left lower lobe stump was intact. The flexible bronchoscope was removed and the endobronchial ultrasound (EBUS) was inserted. Once in the trachea, the balloon was slightly inflated. We performed an inspection of the 4R lymph node station and found node that, after confirmation of the absence of major blood vessel with doppler, we performed an FNA using 15 passes of a 22gauge needle under direct visualization. We made three passes into this lymph node station preparing two slides and sending the rest in cytolight. We repeated this process in the station 7, 11R lymph node stations. We then performed an additional surveillance flexible bronchoscope and ensured hemostasis. The patient's airways were suctioned clear of secretions and the procedure was terminated.
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· The patient was positioned upright and anatomical landmarks were identified. The area was prepped and draped in a sterile fashion. A finder needle was passed through the skin over the approximate 6th rib at which time serosanguinous fluid was freely aspirated. A guidewire was passed freely into the pleural cavity. A small stab incision was made in the skin and the tunnel dilated slightly to accommodate the pigtail catheter. The pigtail catheter was then passed into the pleural cavity over the guidewire and the guidewire removed. We then aspirated fluid through the pigtail which was then sent for cytology. The pigtail was removed and pressure applied. A sterile dressing was then applied
 
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