Documenting and Coding
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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.
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
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
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
- Coders should not confuse BAL with whole lung lavage which is a therapeutic
procedure performed to treat pulmonary alveolar proteinosis under general
- 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
- 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
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:
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
- 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.