BAL

I really hesitate bringing this subject up since mucous plug removal was thoroughly discussed previously. However would appreciate your opinion on the appropriate code(s) for the procedure(s) described below. I have 0BC78ZZ for the mucous plug removal.

My question is in regards to what the MD calls bronchoalveolar lavage. What code would you use?
[cid:image001.png@01D19A5A.B51213D0]

Sharon Salinas, CCS
Health Information Management
Barlow Respiratory Hospital
2000 Stadium Way
Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
Fax: 213-202-6490
ssalinas@barlow2000.org


Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.

Comments

  • edited May 2016
    THANK YOU!!!
    In this case the physician used approximately 80 ml of normal saline and did not collect any specimen. No additional code is necessary for this, correct?
    That is how I looked at it but a reviewer did not agree with me. I was hoping for verification of my reasoning.


  • I'd code in the fashion below, with adjustment for the proper bronchial lobe.



    [cid:image002.png@01D19ADF.456645D0]

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org


  • edited May 2016
    Paul,

    Would you use the code below designating 'diagnostic' even though no sample of fluids was obtained?

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way
    Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    Fax: 213-202-6490
    ssalinas@barlow2000.org




  • H, Sharon

    No...in the case of your example, I'd modify to indicate no sample was obtained. Sorry to confuse the issue, I was posting a typical example of the type of BAL we encounter at our sites. I should have specified that in your question, no sample was obtained.

    Bronchial Procedures can be tricky.

    Key Points
    Was procedure confined within lumen of bronchus or was lung tissue obtained in a transbronchial approach?
    Remember, the Bronchi have lobes, too, and ensure anatomical location for coding purpose - lung versus bronchus.
    If the intent and scope of the procedure and type of any tissue obtained is unclear, the physician should be queried.




    Paul

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org


  • edited May 2016
    I agree. What makes me question this so much is this: Using the code below without the diagnostic designation changes the DRG to the Major Chest Procedures (163-165) DRGs when you have a respiratory dx as principal diagnosis. Just does not feel right...

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, April 20, 2016 8:55 AM
    To: Salinas, Sharon
    Subject: RE: [External] [cdi_talk] BAL

    H, Sharon

    No...in the case of your example, I'd modify to indicate no sample was obtained. Sorry to confuse the issue, I was posting a typical example of the type of BAL we encounter at our sites. I should have specified that in your question, no sample was obtained.

    Bronchial Procedures can be tricky.

    Key Points
    Was procedure confined within lumen of bronchus or was lung tissue obtained in a transbronchial approach?
    Remember, the Bronchi have lobes, too, and ensure anatomical location for coding purpose - lung versus bronchus.
    If the intent and scope of the procedure and type of any tissue obtained is unclear, the physician should be queried.




    Paul

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org


  • I did not perform a scenario in a grouper to judge impact or MS-DRG assignment. There are apparently issues with this year's grouper logic. I agree that a BAL of Bronchus 'should not' impact the MS-DRG. Only select procedures, such as a true transbronchial biopsy of lung tissue, should impact the MS-DRG, in my opinion. This has been the case for past 20 years, and a BAL did not impact DRG in previous versions of the grouper.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org


  • Dr. Gold,
    Below is my original post with the entire report. Is it coming through in the email? I was hoping that the saline lavage could be considered an integral part of the removal of the mucous (since that was the intent) and not coded as a separate procedure since I really do not feel this procedure warrants placing this encounter in the Major Chest Procedure DRGs.
    Thanks,

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, April 19, 2016 4:43 PM
    To: Salinas, Sharon
    Subject: [cdi_talk] BAL

    I really hesitate bringing this subject up since mucous plug removal was thoroughly discussed previously. However would appreciate your opinion on the appropriate code(s) for the procedure(s) described below. I have 0BC78ZZ for the mucous plug removal.

    My question is in regards to what the MD calls bronchoalveolar lavage. What code would you use?
    [cid:image001.png@01D19B15.33BB81C0]

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way
    Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    Fax: 213-202-6490
    ssalinas@barlow2000.org


    Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.



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