Bronchial Washing vs Bronchoalveolar Washing coding

ldurofchalk@outlook.comldurofchalk@outlook.com
edited February 2018 in Clinical & Coding
Can a Bronchoscopy with documented Bronchial Washing RUL be coded as a BAL/Bronchoalveolar Washing for a Surg DRG, or can only Bronchial Washing of RUL bronchus be coded for no impact in DRG?  I'm feeling  a query would be needed to have clarified if that Bronchial Washing included Bronchoalveolar Washing before could code as a BAL.  I have not been able to find any documented guidance in this so thought I post here.  Thanks for your assistance!

Comments

  • afrady@blr.comafrady@blr.com

    Correction Notice: Bronchoalveolar Lavage

    Coding Clinic, First Quarter 2017: Page 51

    Coding advice or code assignments contained in this issue effective with discharges March 13, 2017.

    Coding Clinic, First Quarter 2016, page 26, contained an error regarding the appropriate ICD-10-PCS code for bronchoalveolar lavage (BAL). Code 0B9B8ZX, Drainage of left lower lobe bronchus via natural or artificial opening endoscopic, is not the correct code. BAL involves washing out and sampling alveoli of the lung (small sacs within the lungs). The appropriate code assignment for a BAL is as follows:

    0B9J8ZX 
    Drainage of left lower lung lobe, via natural or artificial opening endoscopic, diagnostic 

    The lung body part values more accurately capture the objective of bronchoalveolar lavage, and coding to the lung is consistent with the general PCS convention of coding treatment of a tubular body part to the furthest anatomical site reached. In this case it is alveolar (lung) tissue.

    ~
  • afrady@blr.comafrady@blr.com
    For what it is worth I tried the OB9JZX as a diagnostic and also tried it with no qualifier as OB9JZZ and I got DRG 168 both times.   (Using pneumonia as the pdx.)
  • ldurofchalk@outlook.comldurofchalk@outlook.com

    So then can I assume that you are saying then that if a Bronchoscopy w/ "Bronchial Washing" is documented, it can be coded as Bronchoalveolar Washing for the Surg DRG?  Just want to confirm...thanks.

  • ldurofchalk@outlook.comldurofchalk@outlook.com

    .......asking since your referenced codes 0B9JZX and 0B9JZZ are BAL codes.  My question refers to if physician documents "Bronchial Washing of RUL bronchus" instead of documenting Bronchoalveolar Washing (for BAL).  I'm thinking this cannot be coded as a BAL and looking for guidance.   Thanks again for any assistance, it is greatly appreciated.

  • ldurofchalk@outlook.comldurofchalk@outlook.com
    Anyone???
  • bbogda@morrishospital.orgbbogda@morrishospital.org
    We would code the bronchial washing of RUL bronchus as drainage of bronchus, right lower lobe (non-valid OR procedure).  If the lavage was documented as BAL or Bronchioalveolar we would code as drainage of lung, RUL, which is a valid OR procedure.
  • lprescott1lprescott1
    I agree with above. if the provider specifically says lavage of the bronchus- you need to apply the code for bronchus as opposed to documentation stating BAL.

  • ldurofchalk@outlook.comldurofchalk@outlook.com
    Thank you for your input!  I will pass this on to our CDI team.
  • afrady@blr.comafrady@blr.com
    Agreed. 
  • RPinson@PinsonandTang.comRPinson@PinsonandTang.com
    A diagnostic BAL (in which a sample is sent for analysis) is coded as 0B9C8ZX (a non-OR procedure).

    Interestingly, a BAL performed purely for therapeutic (non-diagnostic) purposes, typically for thick obstructing secretions, with no sample sent for analysis is coded 0B9C8ZZ which is an OR procedure assigned to a surgical DRG.

    Richard D. Pinson, MD, FACP, CCS
    Pinson & Tang
    CDI Educators and Advisers
    Authors of the CDI Pocket Guide
    www.pinsonandtang.com


  • bbogda@morrishospital.orgbbogda@morrishospital.org
    Dr Pinson - Our system tells us that a diagnostic BAL (0B9C8ZX) in this case Drainage of right upper lung lobe, via natural or artificail opening endoscopic, Diagnostic, codes to a valid OR procedure.
    I believe the difference is not the therapeutic vs diagnostic, it is the lung vs bronchus.  The LUNG will code out to a valid OR procedure whether it is diagnostic or therapeutic.
    Please correct me if I am wrong.
    Respectfully,
    Betty
  • lprescott1lprescott1
    You are correct Betty- it is the location that will determine the BAL as a reimbursable procedure. 
  • jmccorkl@stanfordhealthcare.orgjmccorkl@stanfordhealthcare.org
    Betty, I'm not sure you are correct ... "I believe the difference is not the therapeutic vs diagnostic, it is the lung vs bronchus. The LUNG will code out to a valid OR procedure whether it is diagnostic or therapeutic."

    It seems that Diagnostic vs No qualifier does differentiate whether or not it is considered a valid OR procedure.  Using an encoder, 0B9J8ZX and 0B9J8ZZ are both BAL of lung lobe (not bronchus) but only 'No qualifier' codes to an OR procedure.  

    I have a previous thread about this topic: BAL Diagnostic vs No Qualifier .  This issue is very confusing for me!

    Jeanne McCorkle BSN, RN, CCDS
  • bbogda@morrishospital.orgbbogda@morrishospital.org
    What end-coder are you using?  Unless I am looking at this wrong,  Nuance Clintegrity gives a valid OR assignment for both of 0B9J8ZZ and 0B9J8ZX.  DRG 168. 
  • jmccorkl@stanfordhealthcare.orgjmccorkl@stanfordhealthcare.org
    Both 3M and TruCode encoders differentiate between Diagnostic and No Qualifier.

    Also, from above discussion:
    A diagnostic BAL (in which a sample is sent for analysis) is coded as 0B9C8ZX (a non-OR procedure).

    Interestingly, a BAL performed purely for therapeutic (non-diagnostic) purposes, typically for thick obstructing secretions, with no sample sent for analysis is coded 0B9C8ZZ which is an OR procedure assigned to a surgical DRG.

    Richard D. Pinson, MD, FACP, CCS
    Pinson & Tang
    CDI Educators and Advisers
    Authors of the CDI Pocket Guide
    www.pinsonandtang.com

  • afrady@blr.comafrady@blr.com
    I more or less blindly parroted the coding clinic above, however it seems the current thinking is that the coding clinic above is clearly in error.  See link for rationale.
    https://www.icd10monitor.com/physician-nightmare-coder-quandary-bronchoalveolar-lavage

  • pscheiderichpscheiderich

    Did anyone see the following article?  See link for update.

    https://libmaneducation.com/icd-10-pcs-bronchoalveolar-lavage-problem-solved/?

    Paula Scheiderich, RHIT

  • cselukecseluke
    edited September 2018

    Did anyone see the following article?  See link for update.

    https://libmaneducation.com/icd-10-pcs-bronchoalveolar-lavage-problem-solved/?

    Paula Scheiderich, RHIT

    Yes, I read this yesterday. So it looks like the body part controversy (lung vs bronchus/bronchiole) will be a moot point after October 1. Am I understanding this correctly? I interpret it as we will still code BAL to the lung body part (is alveolar tissue really lung tissue?) but the MS-DRG grouper will not group this procedure to a surgical DRG. 

    I'm assuming transbronchial biopsy will still group to the surgical DRG triplet.
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited September 2018

    My personal perspective is that a BAL should  not have grouped to a Surgical DRG and that this update will correct that grouping logic?   It would be 'correct' to retain transbronchials to Surgical DRGs, again, in my opinion.


    New DRGs assigned with discharges on/after 1 Oct. so we all need to check our coding and DRG assignments.


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