Bronchoscopy: Coverage and reimbursement. (Featured CME Topic: Adverse Effects of Smoking).Bronchoscopy is the inspection of the lumen of the tracheobronchial tree with a lighted optical system or endoscope. A bronchoscope is an instrument for inspecting the interior of the tracheobronchial tree and carrying out endobronchial diagnostic and therapeutic maneuvers, such as taking specimens for culture and biopsy and removing foreign objects. This procedure may be performed with either a rigid bronchoscope or a flexible fiberoptic bronchoscope. During the last several years, the use of the rigid bronchoscope has been rapidly superseded by the flexible bronchoscope. Bronchoscopy has become a valuable diagnostic and therapeutic tool for use in patients with serious pulmonary diseases. Over time, several factors have altered the spectrum of respiratory infections and the likelihood that they will respond to empiric treatment. Among those factors are altered microbial resistance and patients with compromised immune systems. Bronchoscopy with sampling techniques is often needed to establish definitive diagnoses of pulmonary disorders. INDICATIONS AND LIMITATIONS OF COVERAGE AND/OR MEDICAL NECESSITY A. Diagnostic and/or Therapeutic Unexplained wheezing and/or stridor; Abnormal chest radiogram radiogram /ra·dio·gram/ (-gram?) radiograph. ra·di·o·gram n. A radiograph. radiogram (rā´dēōgram), with suspicion of mass or postobstructive process; persistent pneumothorax pneumothorax (n  mōthôr`ăks), collapse of a lung with escape of air into the pleural cavity between the lung and the chest wall. The cause may be traumatic (e.g. ;
markedly elevated hemidiaphragm/diaphragmatic paralysis; vocal cord
paralysis Vocal Cord Paralysis DefinitionVocal cord paralysis is the inability to move the vocal cords and the resulting loss of vocal cord function. Description and hoarseness; chemical and/or thermal burns of the tracheobronchial tree; refractory lung abscess; thoracic trauma of sufficient degree as to warrant concern for disruption of the tracheobronchial tree; unexplained hemoptysis; abnormal or atypical sputum cytology obtained through expectorated sputum; diagnostic bronchoalveolar lavage; suspected pulmonary infection; suspected tracheoesophageal tracheoesophageal /tra·cheo·esoph·a·ge·al/ (tra?ke-o-e-sof?ah-je´al) pertaining to the trachea and esophagus. tra·che·o·e·soph·a·ge·al adj. Of or relating to the trachea and the esophagus. or bronchoesophageal fistula; follow-up of bronchogenic carcinoma; carcinoma of the lung; esophageal carcinoma; mediastinal neoplasm; suspected foreign body in the tracheobronchial tree; obstructing neoplasms; tracheobronchial strictures and stenoses; bronchopleural bronchopleural /bron·cho·pleu·ral/ (-ploor´il) pertaining to or communicating between a bronchus and the pleura or pleural cavity. bron·cho·pleu·ral adj. 1. fistula; assessment of endobronchial tube placement; assessment of potential endotracheal tube-related injury; postoperative assessment of tra cheal, tracheobronchial, or bronchial anastomosis. B. Therapeutic Retained secretions, mucous plugs, blood clots; necrotic tracheobronchial mucosa; foreign bodies in the tracheobronchial tree; hemoptysis; obstructing neoplasms; strictures and stenosis; pneumothorax; bronchopleural fistula; lung abscess; bronchogenic cysts; mediastinal lesions; intralesional injection; endotracheal tube placement; cystic fibrosis; asthma; thoracic trauma; therapeutic bronchoalveolar lavage (pulmonary alveolar proteinosis Pulmonary Alveolar Proteinosis Definition Pulmonary alveolar proteinosis (PAP) is a rare disease of the lungs. Description In this disease, also called alveolar proteinosis or phospholipidosis, gas exchange in the lungs is progressively ); brachytherapy; laser bronchoscopy; photodynamic therapy; electrocautery; cryotherapy. C. Contraindications * When biopsy is not anticipated - unstable asthma - severe hypoxemia - refractory, life-threatening cardiac arrhythmias - unstable angina pectoris - MI within the last six weeks - refractory, severe systemic hypertension - hypercapnia hypercapnia /hy·per·cap·nia/ (-kap´ne-ah) excessive carbon dioxide in the blood.hypercap´nic hy·per·cap·ni·a n. An increased concentration of carbon dioxide in the blood. - increased intracranial pressure increased intracranial pressure Intracranial hypertension, see there (coughing may precipitate herniation herniation /her·ni·a·tion/ (her?ne-a´shun) abnormal protrusion of an organ or other body structure through a defect or natural opening in a covering, membrane, muscle, or bone. ) - uncontrolled seizures * With transbronchial biopsy - uncorrectable bleeding diathesis - uremia uremia (y  rē`mēə), condition resulting from advanced stages of kidney failure in which urea and other nitrogen-containing wastes are found in the blood. and possibly cirrhosis (because of platelet dysfunction
and coagulopathy)
- severe pulmonary hypertension - mechanical ventilation including positive end-expiratory pressure positive end-expiratory pressure n. Abbr. PEEP A technique used in respiratory therapy in which pressure is maintained in the airway so that the lungs empty less completely in expiration. (because of increased risk of pneumothorax) - thrombocytopenia - aneurysms and arteriovenous malformations within the lungs - superior vena cava superior vena cava n. Abbr. SVC A large vein formed by the union of the two brachiocephalic veins and the azygos vein that receives blood from the head, neck, upper limbs, and chest, and empties into the right atrium of the heart. obstruction Procedure Codes 31622 Diagnostic bronchoscopy with or without cell washing 31623 Bronchoscopy with brushing 31624 Bronchoscopy with bronchial lavage 31625 Bronchoscopy with biopsy 31628 Bronchoscopy with transbronchial lung biopsy transbronchial lung biopsy A biopsy from the lung by an endoscopically-guided forceps, used to diagnose benign–eg, interstitial fibrosis, sarcoidosis and malignant–eg, cancer, lymphoma–lesions. See Transbronchial needle aspiration biopsy. ; including fluoroscopic Fluoroscopic (fluoroscopy) An x-ray procedure that produces immediate images and motion on a screen. The images look like those seen at airport baggage security stations. Mentioned in: Hypotonic Duodenography guidance 31629 Bronchoscopy with transbronchial needle aspiration 31630 Bronchoscopy with repair 31631 Bronchoscopy with tracheal dilation and tracheal stent 31635 Bronchoscopy with removal of foreign body 31640 Bronchoscopy with excision of tumor 31641 Bronchoscopy, with nonexcisional treatment of tumor or stenosis 31643 Bronchoscopy, catheter placement of intracavity radioelement 31645 Bronchoscopy, initial aspiration, tracheobronchial tree 31646 Bronchoscopy, subsequent aspiration, tracheobronchial tree 31656 Bronchoscopy, with injection for segmental brochography (fiberscope fi·ber·scope n. A flexible fiber-optic instrument used to view an object or area, such as a body cavity, that would otherwise be inaccessible. only). ICD-9 Codes that Support Medical Necessity 011.00-012.86 Pulmonary tuberculosis and other respiratory tuberculosis 117.3 Aspergillosis 135 Sarcoidosis 136.3 Pneumocystosis 150.0-150.9 Malignant neoplasm of esophagus 162.0-162.9 Malignant neoplasm of trachea, bronchus, and lung 197.0 Secondary malignant neoplasm of lung 212.2-212.9 Benign neoplasm of respiratory and intrathoracic organs 231.2 Carcinoma in situ carcinoma in situ n. A neoplasm whose cells are localized in the epithelium and show no tendency to invade or metastasize to other tissues. Carcinoma in situ of bronchus and lung 231.9 Carcinoma in situ of respiratory system, unspecified 235.7 Neoplasm of uncertain behavior of trachea, bronchus, lung 277.00 Cystic fibrosis, without mention of meconium ileus 480.0-480.9 Viral pneumonia 481 Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia] 482.0482.9 Other bacterial pneumonia 483.0-483.8 Pneumonia due to other specified organism 484.1-484.8 Pneumonia in infectious diseases classified elsewhere 485 Bronchopneumonia bronchopneumonia: see pneumonia. , organism unspecified 486 Pneumonia, organism unspecified 487.0-487.8 Influenza 494.0-494.1 Bronchiectasis bronchiectasis Abnormal expansion of bronchi in the lungs. It usually results when preexisting lung disease causes bronchial inflammation and obstruction. Bronchial wall fibres degenerate, and bronchi become dilated or paralyzed, preventing removal of secretions, which 500 Coal workers' pneumoconiosis 501 Asbestosis 502 Pneumoconioses due to other silica or silicates 503 Pneumoconioses due to other inorganic dust 504 Pneumonopathy due to inhalation of other dust 505 Pneumoconiosis, unspecified 506.0-506.9 Respiratory conditions due to chemical fumes and vapors 507.0-507.8 Pneumonitis due to solids and liquids 508.0-508.9 Respiratory conditions due to other and unspecified external agents 511.9 Unspecified pleural effusion 515 Postinflammatory pulmonary fibrosis 516.8 Other specified alveolar and parietoalveolar pneumonopathies 517.8 Sarcoidosis with lung involvement 518.0 Pulmonary collapse 518.3 Pulmonary eosinophilia 518.81 Acute respiratory failure 518.82 Acute respiratory distress syndrome acute respiratory distress syndrome n. See adult respiratory distress syndrome. 518.83 Chronic respiratory failure 518.89 Other diseases of lung, not elsewhere classified (for lung nodule, pulmonary lesion, pulmonary occlusion) 519.1 Other diseases of trachea and bronchus, not elsewhere classified, (for bronchial obstruction, bronchial stenosis, tracheal stenosis) 519.8 Other diseases of respiratory system, not elsewhere classified (for airway obstruction) 530.84 Tracheoesophageal fistula 710.0 Systemic lupus erythematosus Systemic Lupus Erythematosus Definition Systemic lupus erythematosus (also called lupus or SLE) is a disease where a person's immune system attacks and injures the body's own organs and tissues. Almost every system of the body can be affected by SLE. 710.1 Scleroderma with lung involvement 748.0-748.9 Congenital anomalies of respiratory system 780.6 Fever 784.2 Swelling, mass, or lump in head and neck (for tracheal mass) 784.49 Hoarseness 785.6 Hilar hi·lar adj. Of or relating to a hilum. adenopathy, lymphadenopathy 786.00-786.09 Dyspnea and respiratory abnormalities 786.1 Stridor 786.2 Cough 786.3 Hemoptysis 786.50-786.59 Chest palns 786.6 Swelling, mass, or lump in chest (for hilar/lung mass) 793.1 Nonspecific abnormal findings on lung field (for abnormal chest x- ray) 799.0 Asphyxia 862.8 Multiple and unspecified intrathoracic organs, without mention of open wound into cavity (for chest trauma) 934.1 Foreign body in main bronchus 934.8 Foreign body in bronchioles Bronchioles Small airways extending from the bronchi into the lobes of the lungs. Mentioned in: Bronchoscopy, Chronic Obstructive Lung Disease , lung 934.9 Foreign body in respiratory tree, unspecified 947.1 Burn of larynx, trachea, and lung 996.84 Lung rejection 997.3 Respiratory complications resulting from a procedure V42.6 Status post lung transplant Reasons for Denial * Attempts at bronchial clearance in patients on mechanical ventilation with lobar lo·bar adj. Of or relating to a lobe or lobes. Lobar Relating to a lobe, a rounded projecting part of the lungs. Mentioned in: Congenital Lobar Emphysema lobar pertaining to a lobe. collapse unresponsive to noninvasive therapy. * Tumor ablation bronchoscopies for airway lesions that are obstructing airways less than a lobar orifice. REIMBURSEMENT GUIDELINES Topical anesthesia and its associated preprocedural services, such as injection of morphine, Versed, or Valium, etc, to relieve anxiety and produce mild sedation, are not separately reimbursable. Payment for these services are included in the allowance for the bronchoscopy procedure. The only exception would be when the condition requires the service of an anesthesiologist. When multiple bronchoscopic procedures are billed, payment is made at full value of the highest valued endoscopic procedure plus the difference between the next valued procedure and the base endoscopy. This manner of reimbursement will prevent overpayment because the higher valued endoscopies (31625-31656) have the value of the basic endoscopy (31622) already built into their individual fee schedule amounts. The standard rule for multiple surgeries applies (eg, 100%, 50% for the 2nd through the 5th procedures) when bronchoscopy is performed in conjunction with lobectomy lobectomy /lo·bec·to·my/ (lo-bek´tah-me) excision of a lobe, as of the lung, brain, or liver. lo·bec·to·my n. Excision of a lobe of an organ or a gland. (CPT codes 32480-32491) or other surgical procedures. DOCUMENTATION REQUIREMENTS Bronchoscopic procedures will be allowed at a frequency based on medical necessity. The patient's medical record should support the medical necessity for the bronchoscopic procedure. Lack of documentation to support services beyond established parameters will result in claims being denied. Indications for Bronchoscopic Brachytherapy The majority of patients who undergo endobronchial brachytherapy are those with recurrent non-small-cell carcinoma of the lung in whom prior fractionated external beam thoracic radiation therapy has failed. Its use as an adjunct to primary treatment has yet to be fully defined. References (1.) Bronchoscopy Local Medical Review Policy Effective Date: 01/01/2002. Available at http://www.gamedicare.com/ Policies/319.htm (2.) All current Procedural Terminology Current Procedural Terminology See CPT. (CPT) five-digit numeric codes and descriptions are copyright[C]American Medical Association American Medical Association (AMA), professional physicians' organization (founded 1847). Its goals are to protect the interests of American physicians, advance public health, and support the growth of medical science. , 2002. All rights reserved. From the Department of Practice Management Services, SMA Services, Inc., a subsidiary of Southern Medical Association, 35 Lakeshore Dr, PO Box 190088, Birmingham, AL 35219-0088. |
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