pulmonary: multiple biopsies, transbronchial and endobronchial

ndriley10

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I code for thoracic and pulmonary and am having some confusion about how many different biopsies and FNAs I can bill at one session. For example:

ESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was placed in the operating room. Appropriate timeout had occurred, and the patient was intubated for the procedure using laryngeal mask airway. Initially, a traditional bronchoscopy revealed a slightly tortuous airway with scant secretions noted scattered throughout. There was erythematous mucosa noted throughout the tracheobronchial tree with several yellowish nodules. A representative nodule was seen in the first division right. This was biopsied by endobronchial biopsy with forceps and sent for routine pathology. Following this, I performed a bronchial alveolar lavage in the right middle lobe lateral segment. This was sent for routine cultures as well as cytology and flow cytometry; and 150 mL were instilled and approximately 50 mL of cloudy fluid was returned. Following this, a wash of the right lung was obtained and sent for routine cultures. Following this, I performed transbronchial biopsies in the area of the right upper lobe. These were sent for pathology as well. Additionally, endobronchial biopsies of the main carina were obtained, and these were also sent for pathology.

After this, we transitioned to endobronchial ultrasound, performing an ultrasound-guided needle aspiration of the station 7 lymph node. This was well visualized, and pathology was available on site to confirm lymph node material. I did also send cultures of the station 7 lymph node aspirate for a fungal and AFB culture. I sent final aspirations with lengthened endobronchial ultrasound needle with suctioning for final pathology review. Preliminary diagnosis showed clusters of white blood cells with no discrete granulomas seen so far.

I have so far 31624, 31625, 31628, 31620 and what about the FNA 31629?
 

lisigirl

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Those are the codes I would use. You may need to add modifier -59 to 31625, I think it bundles to the transbronchial biopsies but since it was in a different part of the lung (the main carina), I think you can justify billing it.

Lisi, CPC
eharkler@nmh.org
 

alincoln

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Midlothian, VA
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I agree you have the right codes.
31625 - EBBX in the RUL
EBBX in main carina
31624 - BAL in RML
31628 - TBBX in RUL
31620 - EBUS
31629 - TNBA of LN#7 - RML

The EBBX/31625 of the RUL wouldn't be billed (with or without 59 mod) because it's the same location as the TBBX/31628.
(You can also only bill for one 31625)
The EBBX in the main carina would get you to a new location that wasn't included in the TBBX(RML) or TBNA (RML/subcarinal).
You would put a modifer on 31625 because it is bundled with both 31628 and 31629.

Does that make sense?
 
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