A Case Study Takes a Look at Coding Respiratory System Procedures


A Case Study Takes a Look at Coding Respiratory System Procedures

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A Case Study Takes a Look at Coding Respiratory System Procedures

Preoperative Diagnosis: Left upper lobe mass

peer 1 Procedure Performed: Fiberoptic flexible bronchoscopy; transbronchial lung biopsies; brushings and washings from left upper lobe mass; and bronchial brushings and washings from right lower lobe mass

Operative Technique: The patient was brought to the endoscopy area after multiple half-milligram Versed boluses. Mild sedation was obtained via the right nostril.

A bronchoscope was passed into the airways. The vocal chords, trachea, carina and bilateral tracheobronchial tree were found to be without any endobronchial abnormalities.

The bronchoscope was first focused into the left upper lobe.

Transbronchial lung biopsies, brushings and washings were done under fluoroscopic guidance. No pneumothrorax was observed on fluoroscopy.

Then, the bronchoscope was taken to the right lower lobe and, with the help of the fluoroscopy, more brushings and washings were obtained. The patient tolerated the procedure well. He will have a chest X-ray to rule out pneumothorax in a few hours and, if he is stable, will be discharged.

Postoperative Diagnosis: Left upper lobe mass

ICD-9-CM Codes

Preoperative: 786.6 Swelling/mass/lump in chest

Postoperative: 786.6 Swelling/mass/lump in chest

CPT Codes and Modifiers
To assign the correct code for the above procedure, check the CPT manual index under Bronchoscopy, Biopsy. Code range 31625­31629 is listed to the right of Biopsy. Code 31623 is listed under the next entry–Brushing/Protected Brushing.

To find the correct codes, read each of the descriptions. Be sure to assign modifiers when appropriate, as shown below.

For Facility Component

31628 Bronchoscopy (rigid or flexible); with

transbronchial lung biopsy, with or without

fluoroscopic guidance

31623 Bronchoscopy (rigid or flexible); with brushing or protected brushings

For Professional Component

31628 Bronchoscopy (rigid or flexible); with

transbronchial lung biopsy, with or without

fluoroscopic guidance

31623-51 Bronchoscopy (rigid or flexible); with brushing or protected brushings

Coding Tips
In the procedure above, the surgeon performed biopsies of the lung tissue–transbronchial (meaning through the bronchus into the lung). The surgeon states that a flexible bronchoscope was placed in the bronchus and used to access the lungs.

The method in which the biopsy is taken is important. In the above case, the physician punched a hole in the wall of the bronchus through the wall of the lung to try for a lung biopsy even though the tissue may come back a bronchial biopsy.

Look in the index for the terms Bronchoscopy and Biopsy. The code descriptions will lead you to the correct code. Remember that the surgeon did not state that a needle was used.

The surgeon also performed brushings in the bronchi of both lungs to obtain specimens. Look in the index for the terms Bronchoscopy, then Brushing/Protecting Brushing. The code you will assign is 31623. Modifier 51 is assigned to the professional code to indicate the performance of multiple procedures.

Peggy Hapner is a senior health care consultant and outpatient coding expert with Medical Learning Inc. (MedLearn®), St. Paul, MN.

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