AAPC - American Academy of Professional Coders Respiratory System Procedures Questions and Answers — Questions and Answers
Question 1: A pulmonologist performs a flexible bronchoscopy. During the procedure, a biopsy of a lesion is taken from the right mainstem bronchus. Subsequently, a medically necessary bronchial alveolar lavage (BAL) is performed on a different lesion in the left lower lobe. How should these services be reported?
- 31625, 31624-59 (Correct answer)
- 31625, 31624
- 31622, 31625, 31624
- 31628, 31624-59
Correct answer: 31625, 31624-59
CPT® code 31625 represents the bronchoscopy with endobronchial biopsy. CPT® code 31624 is for the bronchoscopy with bronchial alveolar lavage (BAL). According to National Correct Coding Initiative (NCCI) edits, 31624 is typically bundled into 31625. However, because the BAL was performed on a separate, distinct lesion in a different lobe (left lower lobe vs. right mainstem), it is appropriate to report both services, appending modifier -59 (Distinct Procedural Service) to 31624 to indicate it was performed at a separate anatomic site.
Question 2: When a surgeon performs a surgical nasal/sinus endoscopy, which of the following procedures is always considered an integral part of the service and is NOT separately reportable when performed on the same side?
- Maxillary antrostomy
- Total ethmoidectomy
- Control of spontaneous epistaxis
- Diagnostic nasal endoscopy (Correct answer)
Correct answer: Diagnostic nasal endoscopy
According to CPT® Manual instructions and NCCI edits, a diagnostic endoscopy is not separately reportable with a surgical endoscopy. The surgical procedure inherently includes the diagnostic 'look-see' portion of the service on the ipsilateral side. The other procedures listed are separate surgical procedures that are not automatically bundled.
Question 3: A surgeon performs a direct laryngoscopy under general anesthesia and uses an operating microscope to excise a polyp from the vocal cord. Which CPT® code should be reported for this procedure?
- 31540
- 31541 (Correct answer)
- 31535
- 31525
Correct answer: 31541
CPT® code 31541 accurately describes a direct operative laryngoscopy with the excision of a tumor (polyp) that specifically utilizes an operating microscope or telescope. Code 31540 describes the same excision but without the use of a microscope. Code 31535 is for a biopsy, not a complete excision, and 31525 is for a diagnostic procedure only.
Question 4: A surgeon performs a total ethmoidectomy (31255) on the right side. During the same operative session, the surgeon also performs a maxillary antrostomy (31256) on both the right and left sides. How should these procedures be reported?
- 31255-50, 31256-50
- 31255-RT, 31256-RT, 31256-LT
- 31255-RT, 31256-50 (Correct answer)
- 31255-RT, 31256-LT
Correct answer: 31255-RT, 31256-50
The total ethmoidectomy (31255) was performed only on the right side and should be reported with modifier -RT. The maxillary antrostomy (31256) was performed on both sides, so it should be reported once with the bilateral modifier -50. It is incorrect to apply modifier -50 to 31255 as it was a unilateral procedure.
Question 5: A patient with a large pleural effusion requires drainage. A physician performs a percutaneous procedure, places a small-bore catheter into the pleural space to aspirate the fluid, and leaves the catheter in place for continued drainage, connecting it to a collection system. No imaging guidance was used. What is the correct CPT® code for this procedure?
- 32556 (Correct answer)
- 32554
- 32551
- 32557
Correct answer: 32556
The key phrase is "leaves the catheter in place for continued drainage," which describes the insertion of an indwelling catheter. CPT® code 32556 is for percutaneous pleural drainage with the insertion of an indwelling catheter, without imaging guidance. Code 32554 describes a thoracentesis where the needle or catheter is removed at the end of the aspiration, and 32551 is for an open tube thoracostomy, a different procedure.
Question 6: Which of the following statements is TRUE regarding the coding of a planned tracheostomy?
- A planned tracheostomy is always bundled into major neck surgeries.
- CPT® code 31603 is used for all planned tracheostomies.
- Age is a determining factor, with a separate code for patients younger than 2 years. (Correct answer)
- A planned tracheostomy (31600) and an emergency cricothyrotomy (31605) are reported with the same code.
Correct answer: Age is a determining factor, with a separate code for patients younger than 2 years.
CPT® coding for a planned tracheostomy is age-dependent. Code 31600 is used for a planned tracheostomy, while code 31601 is specifically for the same procedure performed on a patient younger than 2 years of age. Emergency tracheostomy codes (31603, 31605) are different from planned procedure codes.
AAPC - American Academy of Professional Coders Respiratory System Procedures Questions and Answers
A pulmonologist performs a flexible bronchoscopy.
During the procedure, a biopsy of a lesion is taken from the right mainstem bronchus.
Subsequently, a medically necessary bronchial alveolar lavage (BAL) is performed on a different lesion in the left lower lobe.
How should these services be reported?