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Documenting and Coding Bronchoscopy Procedures

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To assign the correct code for bronchoscopies and ensure a smooth pulmonary medical billing process, coders need to understand the physician’s documentation.

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Documenting and Coding Bronchoscopy Procedures

  1. 1. Documenting and Coding Bronchoscopy Procedures Outsource Strategies International 8596 E. 101st Street Suite H Tulsa, OK 74133 To assign the correct code for bronchoscopies and ensure a smooth pulmonary medical billing process, coders need to understand the physician’s documentation.
  2. 2. www.outsourcestrategies.com 918-221-7769 Bronchoscopy is the most common interventional procedure that medical coding companies help pulmonologists report. This pulmonology procedure is used to make a diagnosis for conditions such as persistent cough, blood in the sputum, indication of a mass, nodule, or inflammation in the lung, or evaluation of a possible lung infection. To assign the correct ICD-10 and CPT codes for bronchoscopies and ensure a smooth pulmonary medical billing process, coders need to understand the physician’s documentation – the objective of the procedure, the actual body part being addressed, and the approach used, and whether or not the objective of tissue or fluid removal was diagnostic. There are two types of bronchoscopes - a flexible fiberoptic bronchoscope and a rigid bronchoscope. In most cases, flexible fiberoptic bronchoscopy is performed using conscious sedation, but rigid bronchoscopy requires general anesthesia by an anesthesiologist. The flexible fiberoptic scope option is more popular because of improved patient comfort and reduced use of anesthesia. However, the choice between the flexible fiber optic bronchoscope and the rigid bronchoscope will be made based on patient indications. Diagnostic procedures or treatments done using bronchoscopy include:  Biopsy of tissue  Collection of sputum  Bronchoalveolar lavage or BAL (fluid put into the lungs and then removed) to diagnose lung disorders  Removal of secretions, blood, mucus plugs, or growths (polyps) to clear airways  Control of bleeding in the bronchi  Removing foreign objects or other blockages  Laser or radiation treatment for bronchial tumors  Stent placement to keep an airway open  Drainage of abscess Here are some key considerations for reporting three procedures performed via bronchoscopy -- bronchoalveolar lavage (BAL), biopsy of the bronchus, and bronchoscopy with removal of mucus plugs or foreign body.  Bronchoalveolar lavage (BAL): Sometimes referred to as “liquid biopsy”, BAL is a bronchoscopy procedure performed within the lumen of the bronchus to collect a sample of fluids via “washing” within the bronchus. BAL is one of the most
  3. 3. www.outsourcestrategies.com 918-221-7769 challenging procedures to document as well as to code. A 2017 www.hcpro.com report offers the following guidance to code correctly for BAL: - BAL involves washing out and sampling alveoli of the lung (small sacs within the lung). - Coders should not confuse BAL with whole lung lavage which is a therapeutic procedure performed to treat pulmonary alveolar proteinosis under general anesthesia. - As it involves fluid removal, BAL is coded to the root operation “drainage”. The appropriate ICD code for a BAL is: 0B9J8ZX, Drainage of Left Lower Lung Lobe, Via Natural or Artificial Opening Endoscopic, Diagnostic - Since the BAL of the peripheral airways is included in the code assigned to the body part lung, no extra code needs to be assigned. A recent ICD-10 Monitor report points out that reporting BAL is all about location. The physician’s documentation should clearly indicate whether a procedure performed via bronchoscopy was endobronchial (performed within the bronchus) or transbronchial (in which the instrument pushes past the bronchioles).  Biopsy of the bronchus: Biopsy of the bronchus is another common bronchoscopy procedure. According to the Coding Clinic, this is brush biopsy of the bronchus wherein samples are taken from within the bronchus (intrabronchial) and not the alveolar or lung tissue. Therefore, biopsy of the bronchus should not be confused with a transbronchial biopsy where “the bronchoscope biopsy forceps actually punctures the terminal bronchus and samples of the peribronchial alveoli (lung tissue) are taken”. The correct ICD-10 code for biopsy of the bronchus is: 0BB68ZX, Excision of Right Lower Lobe Bronchus, Via Natural or Artificial Opening Endoscopic, Diagnostic This does not impact MS-DRG assignment.  Bronchoscopy with removal of mucus plugs or foreign body: Obstruction of the airway due to foreign bodies and foreign body aspiration are serious pediatric concern. Bronchial obstruction may also be due to mucus plugs or other endogenous factors. A www.hiacode.com article provides the following example to illustrate how bronchoscopy with removal of mucus plugs or foreign bodies should be coded:
  4. 4. www.outsourcestrategies.com 918-221-7769 A patient undergoes a bronchoscopy for respiratory symptoms. On inspection of the entire bronchial tree, food particles are found in both lower lobes endobronchially and removed by suctioning. Washings were performed and sent for microbiology. In this case, both the right lower lobe bronchus and left lower lobe bronchus had mucus plugs extirpated, and therefore, two codes are needed. The report gives the correct codes for this example as: 0BC68ZZ, Extirpation of Matter from Right Lower Lobe Bronchus, Via Natural or Artificial Opening Endoscopic 0BCB8ZZ, Extirpation of Matter from Left Lower Lobe Bronchus, Via Natural or Artificial Opening Endoscopic Points to note: - Suctioning and washings should not be confused with lung lavage. A therapeutic procedure, whole lung lavage is usually performed for pulmonary alveolar proteinosis. - The mucus plugs are found in the bronchus, and not in the lung. - As the food particles are found “endobronchially”, body part value “bilateral lungs” would not apply. Experienced AAPC-certified coders in medical coding companies can ensure accurate pulmonary medical billing and coding as they have a firm grasp of the anatomic subsections of the complex respiratory system. They will also examine the physician’s documentation to understand how the bronchoscopy was performed, the specific site, and what was done, to report it correctly. They will query the physician to clarify anything that is missing or unclear within the medical record.

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