Respiratory System
General
Guidelines:
BIOPSY
– Is
part of excision / destruction / other type of removal of lesion either
endoscopically or surgically at the same session, Hence biopsy should not be
reported separately.
Even in multiple identical/similar lesions/at different
area - the biopsy code is not separately reported.
Eg:
Patient with multiple nasal polyps,
nasal obstruction & sinus obstruction
Procedure: Polypectomy and ethmoidectomy,
Endoscopy
In this case CPT 31237 (Nasal
endoscopy/surgical/ with biopsy, Polypectomy) should not be reported along with
CPT 31255 (Nasal endoscopy/surgical, with ethmoidectomy) Biopsy is part of the
procedure.
DIAGNOSTIC
ENDOSCOPY
Diagnostic endoscopy of the respiratory system
includes the access region and a separate code should not be used for this routine
evaluation.
Eg
1: Anterior ethmoidectomy is endoscopically performed
In this case it is routine to evaluate the
access region hence diagnostic nasal endoscopy is part of the procedure and
should not be billed separately. (CPT 31231 - 31235)
Eg
2: Fiber optic bronchoscopy
In this case it is routine to evaluate the
access region (nasal cavity, the pharynx and larynx) only the bronchoscopy code
is reported. (Don’t code Nasal endoscopy & laryngoscopy it is included in
bronchoscopy)
When laryngoscopy
is required to perform endotracheal tube placement – Code CPT 31500
(Intubation, endotracheal, emergency procedure)
Laryngoscopy is
required to perform Tracheostomy (Code 31603 – 31614) – don’t code
laryngoscopy.
CPT 31600
Tracheostomy placement (Include routine laryngotomy, laryngectomy,
laryngoplasty codes)
Diagnostic
endoscopy converted into open surgical procedure – Code only open procedure.
Open surgical
procedure is accompanied by an endoscopy at the same session to evaluate the
surgical field - surgical endoscopy is not separately reported.
Diagnostic
endoscopy (sinus endoscopy, laryngoscopy, bronchoscopy, pleuroscopy etc) is included
in surgical endoscopy performed at the same encounter.
Note: If diagnostic
endoscopy is performed and decision is made to perform surgical endoscopy in
post operative period then append modifier 58 as stage procedure
Eg:
Patient with aspiration of foreign body
Bronchoscopy is
performed indicating a foreign body obstruction attempt made to remove
bronchoscopically – Code only 31635 (Surgical bronchoscopy with removal of
foreign body) CPT 31622 (Bronchoscopy diagnostic) is included.
If it is
unsuccessful and decided to perform thoracotomy (Planned) – Diagnostic
bronchoscopy could be separately coded in addition to the thoracotomy. Modifier
58 may be used as staged procedure.
Surgical Sinus
endoscopy includes a sinusotomy and diagnostic endoscopy
Note:
Bleeding control during a procedure
is part of the endoscopy procedure it should not be billed separately. (CPT
30901 (Control of hemorrhage) is part of nasal endoscopy 31235 (endoscopy))
If bleeding is a
late effect and required a procedure in post operative period would be billed
with appropriate CPT and modifier 78 (related procedure)
When endoscopy
procedures are performed – most comprehensive code describing the service
rendered would be reported. If multiple procedures are performed and not
adequate by single CPT – bill the services with appropriate CPT with modifier
51 (Multiple procedures) to the secondary services.