This webinar, led by Shay Lunt from Hagen Consulting Group, focused on CPT coding for bronchoscopy procedures, including code selection, anatomy relevant to coding, procedural guidelines, and NCCI edits.
Shay covered differences between diagnostic and surgical bronchoscopy codes, add-on procedures, and special situations affecting code selection and reimbursement.
Several interactive polling questions clarified coding nuances, and participants were informed about follow-up on outstanding questions that will be addressed via FAQ and a YouTube recording link.
Attendees were encouraged to fill out a survey, and next week’s webinar will cover the PCS codes for bronchoscopy.
Action Items
This week – Kathy: Compile attendee questions, send to Shay, and ensure answers are provided via FAQ and YouTube video.
This week – Kathy: Distribute webinar recording link to all attendees.
This week – Kathy: Publish FAQs addressing all submitted and unanswered questions.
Attendees: Complete the feedback survey for the webinar.
Attendees: Email Shay with any additional bronchoscopy CPT coding questions for follow-up.
Bronchoscopy Anatomy and Procedure Overview
Review of upper and lower respiratory tract anatomy was provided to clarify terminology in bronchoscopy reports and CPT code descriptions.
Description of rigid vs. flexible bronchoscopes and their clinical applications.
Key diagnostic and therapeutic uses of bronchoscopy outlined, including biopsy, lavage, aspiration, tumor removal, stenting, and foreign body extraction.
CPT Coding Guidelines and Code Descriptions
Base code 31622 is used for diagnostic bronchoscopy, with additional codes for specific interventions (e.g., lavage, brushing, biopsy).
Diagnostic bronchoscopy is not coded separately when performed with a surgical procedure; only the surgical code is assigned.
Fluoroscopy is bundled into most bronchoscopy codes, while moderate sedation may be billed separately if documented.
Codes are delineated for location (lobe, bronchus), type of intervention (biopsy, aspiration, stenting), and whether procedures are initial or subsequent within the same session.
Common Coding Scenarios and Polling Clarifications
Multiple biopsies in a single lobe are coded once per lobe; add-on codes apply only when multiple lobes are involved.
Fiducial marker placement, dilation, stenting, balloon occlusion, tumor destruction, valve procedures, and advanced technologies (navigational bronchoscopy, EBUS, thermoplasty) all have distinct codes and bundles.
Polling questions confirmed that bundled procedures (e.g., stenting and dilation) should not be billed separately, and bilateral procedures typically do not require modifier 50 due to code structure.
NCCI Edits, Medicare Payment, and Reporting Rules
NCCI guidance dictates which codes can be billed together, including when to code diagnostic procedures separately if a bronchoscopy leads to an open procedure.
Examples and polling clarified when diagnostic and/or surgical bronchoscopies are reportable in complex cases, such as failed endoscopic attempts followed by open thoracotomy.
Bleeding control and confirmatory bronchoscopies for surgical planning are considered integral and not separately reported.
Medicare’s endoscopy payment rules apply “family” logic, paying the highest-valued code in full and others at the difference from the base code.
Decisions
Do not report diagnostic bronchoscopy separately when performed with a surgical bronchoscopy.
Dilation is bundled with stenting procedures and should not be reported in addition.
Use add-on codes only for additional lobes/bronchi when appropriate, consistent with CPT guidelines.
Open Questions / Follow-Ups
All unanswered participant questions will be compiled, answered by Shay, and published via FAQ and shared YouTube video link.
Some clarifications on coding specific edge cases may be included based on attendee feedback in the published FAQ.