pulmonology/bronchoscopy coding

[aclawson]

Can anyone tell me how to code 31624 BAL & 31623 brush when the physician does multiple times in sub segments? I haven't been able to find anything that says these codes can be billed multiple times during the same bronchoscopy.

 

[jsalzer50]

modifier -51?

I wonder if the 2 codes can be identified and reported by adding modifier -51 (multiple procedures)?

31623-51
31624-51

Does the multiple times in sub segments also document more difficulty than usual? Modifier -22 increased procedural services came to mind, but not sure about it.

 

[aclawson]

pulmonology/bronchoscopy

The note states bronchioloalveolar lavage of right upper lobe anterior subsegment & bronchioloalveolar lavage of right upper lobe posterior subsegment. Endobronchial brushings of right upper lobe also performed.
I would code this with 31624 & 31623. The provider thinks it should be billed as 31624,31624,31623. i have researched and can't find anything that says it can be billed twice during the same procedure.

 

[jsalzer50]

-RT modifier?

Yeah, it seems to me that insurance will deny if 31624 is reported twice. My gut says they would wonder why the doctor did this twice, and it seems they would request supporting documentation. Reading this again, I don't think modifier -51 would apply here. I do agree with you. Would go with: 31624 and 31623. Do you think modifier -RT would be appropriate here because of the specificity of the right lobes? 31624-RT, 31623-RT?

 

[aclawson]

According to our select coder, modifier RT, LT, 50 are all invalid for these procedures. Thank you for your thoughts.

 

[jkoop]

documentation guidelines?

Does anyone know if there are specific guidelines as to documentation for a BAL? Can the provider just state "BAL done in RUL" or do they need to state the amount of saline instilled and the return? Thanks.

 

[elzabet72]

BAL is a once per day code, no matter how many times it is done. The brushings can be billed once per lobe, no matter how many passes in each lobe.

 

[DSFlagg]

Forcep removal of Mucus plug and suctioning

If the physician documents that he removed a mucus plug WITH FORCEPS and also did suctioning, is that all inclusive to the 31645 or is there another code for the forcep removal of the plug?

Thank you!