Pulmonology Coding Alert

Question: What are the most common therapeutic bronchoscopy codes?

California Subscriber

Answer: Usually, prolonged or traumatic intubation or prior tracheotomies brings about the need for therapeutic bronchoscopy. CPT® 31630 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fracture) is commonly used. You would use 31631 (... with placement of tracheal stent[s] [includes tracheal/bronchial dilation as required]) when the pulmonologist expands an area where a lesion protrudes, for instance, scar tissue from previous surgeries.

More codes related to therapeutic bronchoscopy include 31635 (... with removal of foreign body); 31640 (... with excision of tumor); and 31641 (... with destruction of tumor or relief of stenosis by any method other than excision [e.g., laser therapy, cryotherapy]). You would use 31643 (... with placement of catheter[s] for intracavitary radioelement application) for catheter placement for large, endobronchial tumors with substantial submucosal and parancheal tumor load. The physician usually chooses to perform this procedure when external beam radiation can't be provided because of the danger of exposure to adjacent tissues.

Meanwhile, 31645 (... with therapeutic aspiration of tracheobronchial tree, initial [e.g., drainage of lung abscess]) and 31646 (... with therapeutic aspiration of tracheobronchial tree, subsequent) apply to drainage of lung abscesses. For catheter aspiration of the tracheobronchial tree at bedside, use 31725 (Catheter aspiration [separate procedure]; tracheobronchial with fiberscope, bedside).

Other related procedures include electrocautery (for treating endobronchial lesions), neodymiumyttrium-aluminum-garnet laser (for achieving homeostasis in patients with hemoptysis from airway neoplasms) and cryotherapy (for the destruction of tissue by coagulation).