Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

31625,31624, 31623

Janice Posted Wed 09th of January, 2013 14:07:54 PM

i billed medicare for these codes and they paid
31625 - 136.11
31624 - .46 because Payment is reasoncodesed when performed/billed by a provider of this specialty. This change to be effective 7/1/2010: Payment is reasoncodesed when performed/billed by a provider of this specialty. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

31623 - 0 because Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) This change to be effective 07/01/2010: Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

HELP any thoughts as to whats going on

SuperCoder Answered Thu 10th of January, 2013 20:08:21 PM

The bronchoscopy codes fall under Medicare's Multiple-Endoscopy Payment Rule. When multiple endoscopies such as bronchoscopies are performed Medicare pays 100 percent for the highest-valued procedure. The remaining procedures are paid at the allowable fee minus the base (diagnostic) fee for 31622. The payment for 31622 is included in the payment for the highest-valued procedure. Since this payment is "built in" to the intervention codes you cannot be paid for the diagnostic portion more than once. Therefore you have to subtract this dollar amount from the relative value of the remaining procedures performed that day.

Example: The pulmonologist performs a bronchial biopsy (31625) and a transbronchial lung biopsy (31628) at a different site with brushings (31623) and alveolar lavage (31624). List the transbronchial biopsy first with modifier -59 because it has the highest relative value followed by the bronchial biopsy code which has the second-highest relative value. The brushings (31623) and alveolar lavage (31624 with bronchial alveolar lavage) are appended with modifier -51.

The claim form would appear as:
31628-59
31625
31623-51
31624-51.

In this case some payers may reimburse codes with modifier -51 at a 50 or 25 percent level. Other insurance companies may only pay you for one procedure the highest-valued procedure regardless of the interventions performed.

Related Topics