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bronchoscopy

Janice Posted Fri 05th of October, 2012 14:00:34 PM

new to pulmonary would this be 31628,31632,31623, 31624? and what about intubation can i code for that also
thanks so much

The right nostril was anesthetized. The bronchoscope was passed
through the right nostril. The vocal cords were visualized. Lidocaine 2% was
squirted over the vocal cords. Bronchoscope was then passed into the trachea.
There was a thick blood clot noted. It was suctioned, but it did obstruct my
bronch, hence the bronchoscope was withdrawn and the mucus plug was removed.
Patient's bronchoscope was then passed again through the right nostril.
However, patient's oxygen saturations were in the 70s and 80s. Patient's
oxygen saturations would not come up. A decision was made to intubate the
patient. Patient had received etomidate and Diprivan per anesthesiologist. I
have intubated the patient with size 8-mm ET tube without difficulty after
visualizing the vocal cords. Patient tolerated the procedure well. Patient's
oxygen saturation subsequently came up to 99-100%. I proceeded with the
bronchoscopy through the existing ET tube size 8-mm. The trachea below the
tip of the ET tube was visualized. No endobronchial lesions and the main
carina was sharp.

Bronchoscope was then passed into the right bronchial tree. Right upper lobe,
right middle lobe and right lower lobe were visualized. There were no
endobronchial masses or lesions seen. Some thick whitish secretions noted.
There were no mucopurulent secretions noted and the carina was sharp. Next,
bronchoscope was then withdrawn to the main carina, passed into the left upper
lobe and left lower lobe. Similarly, there were no endobronchial masses or
lesions seen. No mucopurulent secretions noted. The minor carina were sharp.
There were some thick whitish mucous secretions noted.

Bronchioalveolar lavage was obtained from the lingula and the left basilar
segment bronchus and also from the right upper lobe segmental and right middle
lobe subsegmental bronchus. The bronchoalveolar lavage was sent for
immunocompromised panel and for cytology. Subsequently, Mucomyst was squirted
into the right and the left bronchial tree and washings were done. There were
no endobronchial masses noted. Patient was left on the ventilator for now on
the tidal volume of 400, rate of 20, FiO2 100%, PEEP of 7. Patient tolerated
the procedure well. An ABG and a chest x-ray will be obtained and patient
will be sedated with propofol IV.

SuperCoder Answered Fri 05th of October, 2012 21:07:06 PM

Hi Janice,

We are working on this. Please be patient till the time.

Experts agree that it is possible for multiple procedures to occur during one bronchoscopy session. If a bronchoscopy session included a BAL (31624, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage), a protected brush sampling (31623, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings), and a transbronchial lung biopsy (31628, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy[s], single lobe) all during one session, then you should report all three procedures. Don't forget to list the most complex procedure first, followed by the less complex codes.

Thank You

Janice Posted Fri 05th of October, 2012 21:52:34 PM

thank-you so much

Janice Posted Mon 08th of October, 2012 12:50:43 PM

are you still working on this??

SuperCoder Answered Mon 08th of October, 2012 18:47:58 PM

1.31628: This code is for lung biopsy. As no lung biopsy is done. So do not use this code.
2.31632: This code is again for lung biopsy. As no lung biopsy is done. So do not use this code.
3.31623: As per your report, there is no documentation of brushing or protected brushing. So this code is also out of way.
4.31624: As per report, bronchoscopy is performed along with bronchoalveolar lavage. So only this code should be used.
5.Modifier 22 can be appended to 31624 to show additional work done such as increased procedure time, intensity, technical difficulty of procedure, or severity of patient’s condition.
6.Intubation is provided to keep the trachea open to improve oxygen saturation. So no need to code this also.

Janice Posted Mon 08th of October, 2012 21:44:33 PM

Thanks

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