BAL and/or Lung Washing

erin.williamsonerin.williamson
in Clinical & Coding
Our coders are arguing that simply BAL's and washings should be coded to the root operation "excision" simply because the MD did a washing and sent it for cytology. It appears to me that the verbiage "brushing and washing" clear states "and" and not "and/or". I am not comfortable with an excision code on the claim when the OP note clearly does not indicate any type of excision nor actually lung tissue being collected.  Am I wrong in my thinking.  Appreciate anything you have to offer!

Comments

  • fishdl@shands.ufl.edufishdl@shands.ufl.edu

    Please check out the previous discussion regarding BAL and the recent Coding Clinic guidance.

    https://forums.acdis.org/discussion/comment/17009#Comment_17009

    Thanks!

  • ellen.jantzer@asante.orgellen.jantzer@asante.org
    We had this same discussion at my facility. Our pulmonologist told me that the term "washing" describes the location meaning fluid or froth was collected in the bronchus at the end of the BAL procedure as the scope was being withdrawn. Cells are obtained but no tissue is collected. A "brushing" is a different tool that is inserted into the scope to scrape the bronchus to collect a tissue sample. This is usually done in the area of a mass or other finding that requires a tissue sample. The encoder links "washings and brushings" together, which can drive the coder to select excision as the root operation, but the definition of excision is "cutting away of tissue" so I don't think a "washing" with water and collection of fluid meets the definition of excision. On the other hand, a brushing meets the definition of excision. At least that is my thought today.....this seems to be an ever changing ICD code...Ellen
  • erin.williamsonerin.williamson
    I appreciate all the input!  I feel the need for an internal guideline coming on!
  • afrady@hcpro.comafrady@hcpro.com
    if coders are taking Bronchoscopy with BAL to an excision of lung....get new coders.
  • slompashirt1slompashirt1
    Amen to that!
    we are having pretty much the same issue. Our coders are trying to use the "alveolar" part of the bronchoalveolar lavage to code a bedside bronchoscopy with BAL to a procedure which indicates that lung tissue was obtained. (drainage of lung endoscopic, diagnostic).  This is a significantly different procedure than a simple bedside BAL (drainage of bronchus, endoscopic, diagnostic), that is intended only to lavage the bronchus to get an accurate microbiology sample to determine organism responsible for infection or response to antibiotic treatment.
    I am predicting another coding clinic to clear this up, hopefully soon!
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