Pulmonology Coding Alert

Question: What is the appropriate code to use for a therapeutic bronchoscopy?
Texas Subscriber   Answer: There are several therapeutic bronchoscopy codes. The underlying cause for a therapeutic broncho-scopy is usually prolonged or traumatic intubation or prior tracheotomies. Code 31630 (tracheal dilation or closed reduction of a fracture) is commonly used. Code 31631 (tracheal dilation with the placement of a tracheal stent) is used when an area is expanded where a lesion protrudes (such as scar tissue from previous surgeries or tumors).
Other codes which apply to therapeutic bronchoscopy are 31635 (removal of foreign body); 31640 (excision of tumor); and 31641 (destruction of tumor or relief of stenosis by any method other than excision [i.e. laser]). Examples of 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).
Code 31643 (placement of catheter(s) for intracavitary radioelement application) applies to large, endobronchial tumors with substantial submucosal and parancheal tumor load, when external beam radiation cant be provided because of the danger of exposure to adjacent tissues.
Finally, 31645 (initial therapeutic aspiration) and 31646 (subsequent therapeutic aspiration) are used for draining lung abscesses. For catheter aspiration of the tracheobronchial tree at bedside, use 31725 (tracheobronchial with fiberscope, bedside).