Chapter 4-Respiratory System-Intro to Procedure Coding

Which codes are for VATS? (99)

32601-32665

Why would a bronchoscopy be done? examples? (97)

-hemoptysis -persistent a cough that is unresponsive to medications -shortness of breath -upper airway obstruction -abnormal chest x-ray or infection

What is a flexible fiberoptic laryngoscopy? (96)

-is a flexible fiberoptic largynoscope, with topical anesthesia and vasoconstrictor -the instrument is passed through the nasal cavity -is a more comfortable approach to visualizing the larynx, the pharynx, and the nasal cavity

List laryngoscopes that are commonly used during a direct laryngoscopy: (95)

1. Kleinsasser 2. Jako 3. Dedo 4. Jackson 5. Lindholm 6. Nagashima 7. Holinger 8. Benjamin

What types of scopes are used for a bronchoscopy? (97)

1. Rigid or open-tube bronchoscope: is inserted into the mouth and is most often used to remove a foreign object or a larger than normal biopsy sample 2. Flexible bronchoscope: Is the more commonly performed type where a flexible tube with many small, glass fibers that allow the transmission of light

What questions should the coder ask themselves before coding a laryngoscopy? (96)

1. What was the PURPOSE of the laryngoscopy? 2. What TYPE of laryngoscopy was used: DIRECT, INDIRECT, or FLEXIBLE FIBEROPTIC? 3. Was STROBOSCOPY used? 4. Was a MICROSCOPE used? If so, code 69990.

What questions should a coder ask before assigning a code for a bronchoscopy?

1. Why was the bronchoscopy performed? 2. Was a diagnostic bronchoscopy performed in conjunction with a surgical bronchoscopy? If so, only the code for the surgical procedure should be assigned. 3. Was the procedure one of the bronchoscopies described by a code from the series 31622 through 31651? If so, a separate code to identify fluoroscopy should NOT be assigned because fluoroscopic guidance is considered part of the procedures identified by that series of codes.

The respiratory system includes surgical procedures involving: (92)

1. nose & sinuses 2. larynx 3. trachea 4. bronchi 5. lungs 6. pleura

Which code identifies a bronchoscopy WITH or WITHOUT cell washings? (97)

31622

Which codes for bronchoscopy include use of a fluoroscope? (97)

31622-31646

Which range of codes are used for bronchoscopes? (97)

31622-31651

What code is assigned when a bronchoscopy is performed to collect specimen(s) with either a fixed brush or PSB? (98))

31623

What does is used for a bronchoscopy with (BAL) bronchial alveolar lavage? (98)

31624

What is the code for Thoractomy, with therapeutic wedge resection (e.g. mass, nodule) initial

32505

What is the code for Thoracoscopy, with therapeutic wedge resection (e.g. mass, nodule), initial, unilateral? (99_

32666

What is a BAL? (98)

A bronchial alveolar lavage that is performed to collect ells from peripheral lung tissue. -During a BAL, sterile saline is instilled into the airway in aliquots of 20 mL up to 50 mL and is then suctioned out and sent for cytological examination.

Describe code 31626 (98)

A stand-alone for placement of fiducial markers, which help mark the positions of a tumor, especially providing guidance to locate lesion in the distal regions of the lung

What is a laryngoscopy with STROBOSCOPY? (96)

A strobe light (bright light, short flashes) is used to better examine moving vocal cords during a laryngoscopy

What are cell washings? (97)

Cell washings are a way of collecting specimens that can be done during bronchoscopies.

Codes 31515-31571 refer to:

Direct Laryngoscopy (95) & performance of procedures such as biopsy, removal of a lesion, arytenoidectomy, and removal of foreign body

How is a VATS performed? (99)

During this surgery, a tiny camera (thoracoscope) and surgical instruments are inserted in the chest through small incisions. The thoracoscope transmits images of the inside of the chest onto a video monitor, guiding the surgeon in performing the procedure.

What are codes 31652 and 31653 for? (98)

EBUS/Endobronchial ultrasound: a relatively new procedure and minimally evasive procedure to diagnose lung cancer, lung infections, and other diseases that cause enlarged lymph nodes in the chest. IT allows physicians to sample lung masses and lymph nodes with the use of ultrasound guidance. So the bronchoscope is inserted into the mouth and a specialized endoscope is fitted with an ultrasound processor and a fine-gauge aspiration needle for performing the biopsy. The real-time imaging allows physicians to view the hard to reach areas. The two codes can be differentiated by the number of samplings.

Describe the "brushings of tissues" specimen collection method: (97)

Either a FIXED BRUSH or a PROTECTED SPECIMEN BRUSH is introduced through the bronchoscope and used to collect a sample of tissue

Codes 31575-31578 refer to: (96)

Flexible Fiberoptic laryngoscopy

Codes 31505-31513 refer to:

Indirect Laryngoscopy (95)

What is the purpose of a VATS? (99)

It can be used for many purposes, including biopsies to removal of tumors or lobes of the lungs.

What is a direct laryngoscopy?

It is a complex procedures where the physician can directly view the larynx

What is code 31632?

It is an add-on code for 31628, bronchoscopy of transbronchial lung biopsy of a single lobe, to include addition lobe biopsies

What is code 31654 for?

It is an add-on code to identify when EBUS is used for diagnostic or therapeutic intervention for peripheral lesion(s). (98)

Do you need to use an additional code when fluoroscopy is used? (97)

No. You do not need to use an additional code, as fluoroscopy is added as additional information to the codes listed in 31622-31646.

What does PSB stand for? (97-98)

PROTECTED SPECIMEN BRUSH: a brush contained inside a double catheter that has a wax plug at the tope that prevents contamination of the specimen from upper airway flora

T/F: A surgical bronchoscopy includes a diagnostic bronchoscopy:

TRUE

T/F: (refer to above statement) Sinusotomy is considered to be part of the endoscopic procedure and is NOT reported separately.

TRUE (92)

T/F: Codes 31231-31297 are considered UNILATERAL procedures so if documentation indicates a BILATERAL procedure (and the specific code does not indicate bilateral), MODIFIER 50 may be used. (92)

TRUE (92)

T/F: The surgical endoscopy includes the diagnostic component. The diagnostic component should NOT be reported separately when performed during the same operative episode.

TRUE (92)

What is VATS? (99)

Video-assisted thoracic surgery

Why would a physician choose to use a forceps to obtain a sample of tissue? (98)

When a lesion can be visualized with the bronchoscope, the physician may choose this method because it allows a more precise sample of tissue to be obtained for pathological diagnosis.

Why is a transbronchial lung biopsy performed and what is done? (98)

When diagnosis of lung disease requires a sample of lung tissue this procedure may be performed. During the bronchoscopy, forceps are used to puncture the bronchus and take samples of the lung tissue. *This procedure is less invasive than an open-lung biopsy and carries a lesser risk of morbidity.

If a physician uses a microscope during a direct laryngoscopy, is the code assignment affected? (95)

YES, the coding professional should watch for terms such as microlaryngoscopy used in the operative report and report code 69990, use of operating microscope, in addition to any laryngoscopy code.

What is code 31628 used for? (98)

a bronchoscopy with a transbronchial lung biopsy of a SINGLE lobe

What is the code for 31627 for? (98)

an add-on code for the fiducial marker placement (computer-assisted image-guided navigation)

What is a laryngoscopy?

an endoscopic procedure that allows the physician to visualize the larynx, or VOICE BOX. (95)

What is a bronchoscope? (97)

an instrument used for viewing that can inserted into the nose or mouth and passed through the trachea, past the larynx, and into the bronchial tubes

What are fiducial markers? (98)

are markers that are placed to help mark the position of a tumor, especially providing guidance to locate lesions in the distal region of the lung

What is code 32997 for? (98)

assigned for total lung lavage (unilateral)

What is one advantage to using the "brushing of tissue" method of specimen collection? (97)

brushings allow the diagnosis to be made on the basis of tissue that could not be obtained normally with biopsy forceps

Which codes are for NASAL SINUS endoscopic procedures? (92)

codes 31231-31297

Codes 31505-31579 describe:

diagnostic and surgical endoscopic procedures of the larynx (Codes may be either diagnostic or surgical) (95)

The purpose of the nasal sinus endoscopes can be either _____________ or _________________ in nature/ (92)

diagnostic or surgical

What is fluoroscopic equipment? (97)

equipment that serves as an image INTENSIFIER and is frequently used during bronchoscopies.

What is code 31579 for? (96)

laryngoscopy with STROBOSCOPY

What is a segmental resection? (99)

removal of a large portion of the lung lobe (larger than a wedge resection)

What is a pneumonectomy? (99)

removal of entire lung

What is a lobectomy? (99)

removal of one lobe of the lung; removal of two lobes is called BILOBECTOMY

What is a wedge resection? (99)

removal of small, wedge-shaped portion of the lung

How are cell washings performed during bronchoscopies? (97)

saline solution is introduced into the airways, which is then removed and sent to the laboratory for cytological examination

What do Nasal sinus endoscopies allow the physician to view? (92)

the interior of the nasal cavity, the middle and superior meatus, the turbinates, and the sphenoethmoid recess

What is an indirect laryngoscopy? (95)

the simplest way to examine the larynx -one technique uses a mirror and light to visualize the oropharynx, posterior third of the tongue, lateral lalaryngeal walls, posterior pharyngeal wall, epiglottis, valleculae, and piriform sinuses. May also view aryepiglottic folds, posterior epiglottis, and vocal cords -Requires a great deal of skill on the part of the physician -Cannot be performed on people with a strong gag reflex or small children

What are codes 32440-32540 for? (98-99)

they refer to surgical procedures such as RESECTION of segment, pneumonectomy, or wedge resection.

Why is a patient usually put under general anesthesia for a direct laryngoscopy? (95)

to avoid the gag reflex

What is the most frequent purpose of a bronchoscopy? (97)

to obtain tissue to allow the physician to make an accurate diagnosis