Respiratory Question for the Week of July 3, 2017

Question:

Can 31645 be billed when the doctor dictates that “mucous secretions were suctioned out of the lower left lobe”? Does it have to be an abscess or mucous plug that was removed in order to use this code?

Answer:

Clearing (e.g., irrigation, aspiration) of mucus secretions is commonly performed during bronchoscopy procedures. Some patients have increased mucus production with conditions such as asthma and COPD, cystic fibrosis, or it could be a symptom of a more significant problem. If the pulmonologist is clearing the mucus to only get a better visualization of the lung during a study, then this work is integral to a diagnostic bronchoscopy (CPT codes 31622–31624). CPT code 31645 is a surgical bronchoscopy code. The intent of the procedure is to be therapeutic in nature after a study of the anatomy and condition is performed. A bronchoscopy performed to relieve mucus hypersecretion, remove mucus plugs, treat an infection or abscess, may be appropriately coded using CPT code 31645 for initial therapeutic aspiration and 31646 for subsequent treatment.