星空入口

Coding Corner: Case Study- Beat Bronchoscopy Coding Troubles

The key: Location, location, location

Correct bronchoscopy coding depends on two crucial pieces of information: where on the body (that is, multiple lobes or locations) the procedures occurred and what method the physician used for the cell washing and biopsies.
Hunt Down Every Detail
A common problem that coders run into is failing to include all aspects of the procedure the physician completed (that is, the biopsy locations, in addition to the number of biopsies he obtained and the techniques he used to obtain them). Avoid the biggest coding pitfall: Make sure the payers won't consider your bronchoscopy bundled into another procedure.
Test yourself with the following example - provided by Vicky O'Neil, CPC, CCS-P, compliance coordinator in St. Louis, Mo. - to see whether you can accurately apply 31628 and the accompanying diagnosis codes.
Master This Sample Report
Pick out the necessary details from this typical operative report:
History: The patient is a 42-year-old male with a history of chronic obstructive pulmonary disease (COPD). The patient underwent a post-bilateral lung transplant six months before the current procedure due to the COPD diagnosis.
Patient has 10-day history of increased shortness of breath and previously noted airway stenosis post-transplant.
Preprocedure diagnosis: Airway stenosis and shortness of breath status post bilateral lung transplant.
Premedications: 0.4 mg Atropine IM.
Anesthesia/Sedations: 20 ml of 1% Lidocaine topical, 6 ml of 2% Lidocaine topical, 10 mg Versed intravenous push (IVP), and 150 mg Fentanyl IVP.
Procedure: The physician advanced the bronchoscope past the vocal cords and over the #8 endotracheal tube (ETT). He then passed the scope through both anastamoses and removed thick secretions from the patient's bilateral airways. He next observed that secretions were most abundant in left upper lobe and left lower lobe.
The doctor then completed a bronchial alveolar lavage (BAL) of the lateral subsegmental right lower lobe. He instilled 100 ml of saline into the patient's right lower lobe, and the operator received a return of 35 ml of fluid. He then completed transbronchial biopsies x 13 in the right lower lobe.
 
The patient tolerated the procedure well without any immediate complications. The physician confirmed that the patient did not show signs of pneumothorax using fluoroscopy.
Estimated blood loss: 20 ml.
Home In on Right Lobe Procedures
You should report codes 996.84 (Complications of transplanted lung), status/post lung transplant (V42.6), 519.1 (Stenosis of bronchus or trachea), and 786.05 (Shortness of breath) to cover every detail of the patient's condition during the procedure.
Although the physician obtained multiple transbronchial biopsies, he took all of the biopsies from the right lower lobe. Therefore, you [...]

- Published on 2005-04-13