Let's face it, medical coding can be as exciting as watching paint dry. But, hey, at least we're not the ones stuck holding the bill! This week we are going to take a look at how AI and automation are going to change the way we bill for procedures. We'll look at code 31652. If you think that's a boring number, wait until you hear about the modifier 51! Joke: What did the medical coder say to the patient? "Don't worry, I'll make sure you get top dollar for that procedure."

What is correct code for Bronchoscopy with Endobronchial Ultrasound (EBUS) Sampling, One or Two Lymph Node Stations or Structures, with Fluoroscopy Guidance

Welcome to the world of medical coding! Today we will explore the intricacies of coding for bronchoscopy procedures, specifically focusing on the procedure involving endobronchial ultrasound (EBUS) and the use of appropriate modifiers to accurately represent the complexity and nature of the procedure.

The code we'll be examining is 31652. This CPT code is used to bill for bronchoscopy, rigid or flexible, with endobronchial ultrasound (EBUS) guidance. It's crucial to note that CPT codes are proprietary to the American Medical Association (AMA) and using them without a valid license is against the law. For accurate and compliant coding, you MUST obtain a license from the AMA and use only the latest CPT codebook published by the AMA to avoid legal consequences.

Use Cases for Code 31652

Let's delve into some real-world scenarios to understand how 31652 might be used:

Use Case 1: The Persistent Cough

Imagine a patient presenting with a persistent cough that hasn't responded to conventional treatment. The physician, suspecting a potential lung malignancy, decides to perform a bronchoscopy with EBUS sampling. After obtaining informed consent from the patient, the procedure commences.

The physician inserts a flexible bronchoscope into the patient's airways, using fluoroscopy for guidance. During the procedure, an ultrasound probe is advanced through the bronchoscope, allowing for visualization of the lymph nodes and surrounding tissues. The physician then proceeds to obtain tissue samples from one lymph node station in the hilum of the lung.

Question: Why use code 31652 in this scenario? Answer: The code 31652 accurately reflects the procedure performed. It accounts for the bronchoscopy with fluoroscopy guidance and the EBUS sampling of one lymph node station, all within the context of a comprehensive evaluation for potential malignancy.

Use Case 2: The Unclear Pathology

Another patient presents with a suspicious nodule in their lung, detected on a chest X-ray. The pulmonologist, after examining the patient's medical history and imaging results, decides that a bronchoscopy with EBUS sampling is the best course of action to clarify the nature of the nodule.

The physician, using fluoroscopic guidance, guides a flexible bronchoscope into the patient's airways. The physician then performs EBUS-guided sampling from two different lymph node stations: one in the mediastinum and one in the hilum of the lung.

Question: Why is code 31652 used again, despite sampling two stations? Answer: Code 31652 allows for the coding of either one or two mediastinal and/or hilar lymph node stations or structures. The fact that the procedure involved sampling from both areas is still captured by the code.

Use Case 3: An Unexpected Finding

Now, imagine a patient undergoing bronchoscopy for a suspected infection. While the physician is examining the patient's airways, they notice an unusual lesion. The physician, acting on instinct and professional responsibility, decides to obtain tissue samples of the suspicious lesion using the bronchoscope's integrated EBUS capabilities. The physician is able to access two lymph node stations.

Question: Would code 31652 still be appropriate in this case, even though the primary objective of the bronchoscopy wasn't focused on lymph node sampling? Answer: While the original goal of the procedure was not focused on lymph node sampling, code 31652 can still be reported since the EBUS was used for sampling two mediastinal lymph node stations. In such situations, it's essential to document the unexpected finding and the reason for the additional EBUS sampling to support the medical coding.

Understanding Modifiers in Medical Coding

In medical coding, modifiers provide essential information that can add detail and clarification to a CPT code. Modifiers are a crucial part of ensuring accurate billing and can significantly impact reimbursement.

Since there are no modifiers listed with this code in the data, let's look at a few modifiers that are commonly applied to coding in other specialties.

Modifier 51 (Multiple Procedures): When a physician performs multiple surgical procedures during the same surgical session, Modifier 51 may be applied. This modifier signifies that the reported procedure was part of a multiple-procedure session. It indicates that the charge should be reduced for the specific procedure to account for the additional work already encompassed by other procedures in that session. In essence, the code isn't completely "doubled" but adjusted for the second procedure, reflecting the reality of multiple tasks during a single session.

Modifier 59 (Distinct Procedural Service): This modifier is often used in coding scenarios where two separate and distinct surgical procedures are performed during the same operative session. Each procedure requires individual effort, separate preparation, and distinct results. Modifier 59 serves to explicitly indicate that the two services are discrete and should be considered separate entities for billing purposes. By applying Modifier 59, the medical coder ensures that the complexity and effort associated with each individual procedure are properly recognized and reimbursed by insurance.

Modifier 73 (Discontinued Outpatient Hospital/ASC Procedure Prior to Administration of Anesthesia): This modifier is used when a planned surgical procedure was halted before the administration of anesthesia. It indicates that the procedure was interrupted, and the patient did not receive any anesthesia related to it. This modifier clarifies why the procedure was stopped, especially if it happened for non-medical reasons, and allows the billing party to submit for payment accordingly.

The accurate and responsible application of modifiers is essential to ensure proper reimbursement and adherence to billing compliance regulations. In some scenarios, using the wrong modifier could potentially lead to accusations of fraud or overbilling. Remember, as a professional medical coder, always stay informed, updated, and ethically grounded.

Beyond the Code: A Word About Medical Coding Best Practices

This article provides just a small glimpse into the complexities of coding in the surgical and respiratory specialties. You should always consult the AMA's official CPT codebook and relevant coding resources for the most up-to-date and accurate information. Staying current with changes in medical coding is a vital aspect of ethical and legal compliance.

Remember that accurate medical coding isn't just about applying the right codes; it's about translating the medical language of a doctor into a comprehensive picture for billing and healthcare administrators. It is the vital link that bridges the gap between clinical practice and reimbursement.

Learn the correct CPT code for Bronchoscopy with Endobronchial Ultrasound (EBUS) Sampling using AI automation. Discover how AI helps in medical coding and billing accuracy for this specific procedure.

What CPT Code is Used for Bronchoscopy with EBUS Sampling?