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EBUS Billing and NCCI Edits

On January 1, 2016 the CPT code for endobronchial ultrasound (EBUS) 31620 was replaced by three new codes that better describe the procedure as it is currently performed. The codes now differentiate the use of EBUS in sampling proximal lesions using a convex probe and more distal lesions using a radial probe. As with all bronchoscopy procedures, the diagnostic code, 31622, is included within these three new codes and the multiple endoscopy rule applies.

CPT code 31652 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/ biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures is utilized when one samples two or less proximal structures. CPT code 31653 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures is utilized when one samples 3 or more structures. 31652 and 31653 may NOT be used together.

Use the code that best describes the work that was performed. These two codes include the work of sampling and therefore one does NOT use the transbronchial needle aspiration codes 31628, 31629 31632 and 31633 with either 31652 or 31653 if only sampling of the mediastinal and hilar structures occurs. If additional bronchoscopic evaluation is performed on structures distal to the hilar structures then use of other bronchoscopic codes is appropriate with codes 31652 and 31653.

CPT code 31654 with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s]) is an “add-on” (ZZZ) code that is used when peripheral lesions (distal to the hilar structures) identified by radial EBUS are sampled. As such, code 31654 MAY be used with any other bronchoscopy codes.

Unfortunately, when CMS originally published the National Correct Coding Initiative (NCCI) edits for the new codes there were errors present. NCCI edits are used to instruct CMS payers and clinicians when two distinct CPT codes may or may not be used together. The NCCI edits for 31652 and 31653 published on January 1, 2016 had a values of “0” for all other bronchoscopy codes. This instructed payers to reject any claims for 31652 or 31653 if any other bronchoscopy code was appended. The societies alerted CMS to these problems and the NCCI edits were corrected. It is now appropriate to code for bronchoscopy procedures performed in addition to EBUS with a convex probe sampling proximal lesions. However, the corrections did not take effect until April 1, 2016. It is, therefore, possible that some claims using codes 31652 and 31653 will have been rejected by CMS and other carriers from January 1 until April 1. Therefore, all claims for EBUS procedures using these codes during this time should be reviewed and resubmitted if rejected by payers.

Last Reviewed: November 2016