Updated on: June 22, 2012

RAC Expected to Target Bronchoscopes and Excessive Unit Coding

Original story posted on: September 16, 2009

sdraperBy Sandra L. Draper, RHIT, CCS

One of the first CMS-approved audit issues announced by RAC regions C and D involves the correct billing for bronchoscopy services. The issue focuses on several CPT codes that only should be reported once per each date of service.

A complete reading and understanding of the descriptions of such codes is essential if coding is to be done correctly. This article discusses each of the codes associated with the identified RAC issue and provides information on how they are to be used for billing multiple services.

31625 - Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy(s);
single or multiple sites.

Bronchial mucosal biopsies, CPT code 31625, are obtained by direct vision, and only one unit may be reported regardless of how many anatomical sites are biopsied during a visit occurring on any given day.

Documentation should indicate that after diagnostic evaluation of the bronchus occurs, a sample of bronchial or endobronchial tissue is removed for study. If a coder consults the description of 31625 (see underlined portion), it should be clear that this code only may be assigned once per patient, per encounter. The only exception occurs in the rare instance that two separate encounters occur on the same day; then a modifier -59 must be reported.

31628 - Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy(s);
single lobe.

Transbronchial lung biopsies, CPT code 31628, are obtained peripherally using fluoroscopic guidance of the biopsy forceps. Reporting multiple transbronchial biopsies performed during a visit occurring on any given day, using 31628, is not permitted because the code description specifically states that it only covers a single lobe. There is an add-on code (31632) that denotes transbronchial lung biopsies taken from different lobes.

This code is reported for each biopsy performed in each additional lobe. A 31632 would not be reported for multiple biopsies taken within the same lobe. Because there is an add-on code, it never would be acceptable to report more than one unit of 31628 on the same patient within the same procedure. 31628 - Includes Notes:  All biopsies taken from lobe

        • Excludes Notes:  Transbronchial biopsies of additional lobe(s) (31632)

Example:  A patient presents with cough, infiltrate, and mediastinal adenopathy. A scope is advanced down the right and left tracheobronchial trees, which are examined to the sub-segmental level.  Multiple biopsies under fluoroscopic guidance are taken from the upper lobe and the lower lobe. Codes 31628 and 36132.

31629 - Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; transbronchial needle aspiration biopsy(s);
tracheas, main stem, and /or lobar bronchus (i)

These biopsies are taken centrally via penetration of a large airway with a biopsy needle. The same reporting structure listed above also is utilized for this type of biopsy. There is an add-on code, 31633, which is used for each biopsy taken from each additional lobe. 31633 would not be reported more than once for multiple biopsies taken within the same lobe.

}31629 - Includes Notes:  all biopsies from same lobe

Excludes Notes:  Transbronchial biopsies of lung (31628, 31632)

Transbronchial needle biopsies of another lobe(s) (31633)

About the Author

Sandra L. Draper is the Director of HIM Practice for Precyse Solutions and is an experienced health information professional with over 20 years of HIM management experience. She has a record of consistent success in advancing health information management department's participation in revenue cycle performance, improving accounts receivables, and DNFB reduction through project management.

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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