CPT code 31633 is for an additional bronchoscopy procedure involving a needle biopsy, used by healthcare providers for documentation and reimbursement.
CPT code 31633 is used to describe an additional procedure performed during a bronchoscopy, specifically for a needle biopsy. This code is an add-on, meaning it is used in conjunction with the primary bronchoscopy procedure code when a healthcare provider performs an extra needle biopsy during the same session. The needle biopsy involves using a needle to collect tissue samples from the lungs or surrounding areas for diagnostic purposes, such as identifying infections, inflammation, or cancer. This code helps ensure accurate billing and reimbursement for the additional work and resources involved in performing the biopsy.
For CPT code 31633, which involves bronchoscopy with needle biopsy, additional modifiers may be necessary to provide specific details about the procedure performed. Here is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 26 - Professional Component: Used when the service provided is the professional component only, such as the interpretation of the procedure.
2. Modifier 50 - Bilateral Procedure: Applied if the procedure was performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This indicates that the bronchoscopy with needle biopsy was one of several procedures.
4. Modifier 52 - Reduced Services: Indicates that the procedure was partially reduced or eliminated at the discretion of the physician.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Applied when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Indicates that the patient required an unplanned return to the operating room for a related procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when the procedure is unrelated to the original procedure and occurs during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Indicates that an assistant surgeon was necessary for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required due to the unavailability of a qualified resident.
12. Modifier 99 - Multiple Modifiers: Used when more than four modifiers are necessary to describe the service provided.
These modifiers help clarify the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is essential to select the appropriate modifiers based on the specific details of the procedure and the payer's guidelines.
CPT code 31633 is subject to reimbursement by Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) overseeing the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to pay doctors or other providers/suppliers. CPT code 31633, like other codes, is evaluated annually to determine its reimbursement rate, if applicable. Providers should consult the latest MPFS to verify if CPT code 31633 is listed and to understand the associated reimbursement rate.
Additionally, MACs play a crucial role in determining the reimbursement of CPT codes. These contractors are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that can affect whether a particular service is reimbursed. Therefore, healthcare providers should check with their regional MAC to confirm if CPT code 31633 is covered and to understand any specific documentation or billing requirements that may apply.
In summary, while CPT code 31633 may be reimbursed by Medicare, providers must verify its status on the MPFS and consult their MAC for any regional coverage policies that could impact reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 31633, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
