Multiple Bronchoscopy Coding Crash Course

Posted on 28. Jan, 2009 by Editor in Hot Coding Topics

Head off denials & ratchet up reimbursement with these modifier tips.

With frigid temperatures expected to hold steady through a bleak winter, respiratory complaints are sure to be on the rise in your office. Knowing Medicare’s Multiple-Endoscopy Payment Rule is essential when you’re coding for bronchoscopies.

Extra: New revenue opportunities for multiple, short inpatient E/M visits during the same day, on-demand from Kim Garner-Huey.

The basics: When your pulmonologist performs multiple bronchoscopies, Medicare reimburses …

… 100 percent for the highest-valued procedure. Then, you get paid for each remaining procedure at the allowable rate minus the base rate for a diagnostic bronchoscopy: 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]).

Payers deduct the base rate from each bronchoscopy code reported after the first because the base bronchoscopy value is included in the payment for the highest-valued procedure. And since the base payment is “built in” to all bronchoscopy codes, you can’t expect payment for the initial diagnostic portion more than once. Therefore, you have to subtract the dollar amount for the diagnostic portion from the value of the remaining procedures performed that day.

Example: If your pulmonologist performs a bronchoscopy on a patient with a localized pneumonia, the procedure might include a BAL (31624), a protected brushing (31623), and a transbronchial lung biopsy (31628), all during the same session, explains a recent American Thoracic Society (ATS) Coding and Billing Quarterly article.

Since the transbronchial lung biopsy is the most complex, you should code it first, followed by the less complex codes, according to the ATS example. You can report all three codes without modifiers since there are no bundling issues with these three codes. Additionally, modifier 51 (Multiple procedures) is...

Tags: 31622, 31623, 31624, 31628, bronchoscopy, multiple bronchoscopies, NCCI, pulmonology