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Coding Tip of the Month – March 2020

Topic: Endoscopic Lung Biopsies

An endoscopic biopsy of the bronchus involves passing an endoscope into the lumen of the trachea and bronchus.  An endoscopic biopsy of the lung is performed by passing an endoscope through the trachea, main bronchus, smaller bronchi and into the lung. Biopsies of the bronchus and lung can be performed using several techniques. Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic depending on the technique used to obtain the sample and whether the biopsy material is fluid, cells or tissue.  This is demonstrated in the PCS Alphabetic Index:


  • see Drainage with qualifier Diagnostic
  • see Excision with qualifier Diagnostic
  • see Extraction with qualifier Diagnostic

Root Operation:

A. Brush Biopsy: A brush biopsy is a small brush that is used to scrape samples of a suspicious spot and the sample of cells is then sent to a lab for analysis. A brush biopsy fits the root operation definition of Extraction – pulling or stripping out or of all or a portion of the body part by the use of force.

B. Needle Biopsies: Needle biopsies can be performed using two types of needles – fine needle and core needle – the type of needle used may impact the correct selection of the root operation.

  • A fine needle aspiration (FNA) biopsy is performed when material is aspirated with a fine needle and the cells or liquid is examined by cytology. FNA typically use a 20 or 21 gauge needle. Fine needle aspiration that removes cells is coded to the root operation “Extraction”. Fine needle aspiration that removes fluid is coded to the root operation “Drainage”.  The appropriate root operation selection depends on careful review of the procedure and pathology documentation. Drainage is more likely to be performed on fluid filled cysts or abscesses.
  • A core needle biopsy is typically performed with a larger bore needle to obtain a core sample of tissue for histopathological evaluation.  Core biopsies are performed with an 18, 16, 14 gauge needle. Core needle biopsy goes to the root operation “Excision” because the larger bore needle “cuts” a core of tissue from the body part. Txcision is more likely to be performed on solid nodules or masses. 

C. Bronchoalveolar Lavage (BAL): Bronchoalveolar lavage is also called a liquid biopsy and is a diagnostic procedure performed via a bronchoscope and it involves washing out tissue of the lung and airways to obtain a small sampling of tissue. BAL is coded to root operation “Drainage” because it involves removing fluid. An exception to this is when the lavage is done for the purpose of removal of a mucus plug – in these cases assign the root operation “Extirpation”.


AHA 2019 Coding Handbook – Chapter 19

Coding Clinic:

  • Third Quarter 2017 (p. 4)
  • First Quarter 2017 (p.4)