AJ's Pediatric Bronchoscopic Billing Guide
Quick Reference on Pediatric Bronchoscopy Billing
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Basic Flexible Bronchoscopy
31622BronchoscopyDiagnostic bronchoscopy for evaluation of the airways.
31623Bronchoscopy + brushingDiagnostic bronchoscopy with brushing(s) for cell studies (such as PCD evaluation).
31624Bronchoscopy + BALDiagnostic bronchoscopy with bronchoalveolar lavage.
31635Bronchoscopy + foreign body removalBronchoscopy with foreign body removal; includes any tool used. Consider modifier 22 (document time and/or complexity), adding 31645 (if therapeutic aspiration of mucus done), or adding 31624 (if BAL done).
31502Tracheostomy tube changeTracheostomy tube change; consider modifier 51 to ensure reporting as a secondary procedure.
31645Bronchoscopy + aspiration, initialTherapeutic bronchoscopy with aspiration of secretions/mucus; initial.
31646Bronchoscopy + aspiration, subsequentTherapeutic bronchoscopy with aspiration of secretion/mucus; subsequent. Used during same hospital stay.
31575Flexible laryngoscopyDiagnostic flexible laryngoscopy. Can be reported as a separate procedure from flexible bronchoscopy if they are done separately (i.e. bronchoscopy done through artificial airway, including tracheostomy); consider modifier 51 to ensure reporting as secondary procedure.
Advanced Flexible Bronchoscopy
31625EBBxDiagnostic bronchoscopy with endobronchial biopsy(s).
31628TBBx, single lobeDiagnostic bronchoscopy with transbronchial lung biopsy, one/first lobe. Additional lobes should include 31632.
31632ADD-ONTBBx, each additional lobeUsed with 31628; bill one unit per additional lobe biopsied.
31629TBNADiagnostic bronchoscopy with transbronchial needle aspiration (TBNA). If TBNA of a lymph node(s) is performed with EBUS guidance, use 31652/31653.
31633ADD-ONTBNA, each additional lobeUsed with 31629; bill one unit per additional lobe targeted
31654ADD-ONPeripheral EBUS (radial probe)Used with 31628 or 31629 to indicate use of radial/peripheral EBUS
31627ADD-ONComputer-assisted navigationUsed when a navigational component is used to assist (i.e. CT); fluoroscopy is included with standard biopsy codes. Ensure operative report includes appropriate documentation.
31652Central (linear) EBUS-TBNA, 1–2 stationsDiagnostic bronchoscopy with endobronchial ultrasound-guided TBNA; 1–2 mediastinal/hilar lymph node stations.
31653Central (linear) EBUS-TBNA, 3+ stationsDiagnostic bronchoscopy with endobronchial ultrasound-guided TBNA; 3+ mediastinal/hilar lymph node stations. Used instead of 31652.
31634Balloon occlusionDiagnostic (and possibly therapeutic) bronchoscopy with balloon occlusion of the airway to assess air leak. May include administration of occlusive substance (i.e. fibrin glue).
31647EBV placement, initial lobeDiagnostic and therapeutic bronchoscopy with endobronchial valve (EBV) placement, initial lobe. Includes balloon occlusion and sizing. May include multiple valves in the same lobe. Includes fluoroscopy.
31651ADD-ONEBV placement, each additional lobeUsed with 31647. EBV placement, each additional lobe. Includes balloon occlusion and sizing. May include multiple valves in the same lobe.
31648EBV removal, initial lobeDiagnostic and therapeutic bronchoscopy with endobronchial valve (EBV) removal, initial lobe. May include removal of multiple valves in the same lobe. Includes fluoroscopy.
31649ADD-ONEBV removal, each additional lobeUsed with 31648. EBV removal, each additional lobe. May include removal of multiple valves in the same lobe.
31630Balloon dilationDiagnostic and therapeutic bronchoscopy with tracheal and/or bronchial dilation.
32997Whole lung lavageDiagnostic and therapeutic bronchoscopy with whole lung lavage.
31641Tumor destruction or relief of stenosisDiagnostic and therapeutic bronchoscopy with destruction of tumor or relief of stenosis by any method other than excision (cryotherapy, APC, laser therapy, electrosurgery).
31636Stent placementDiagnostic and therapeutic bronchoscopy with placement of tracheal or bronchial stent. Includes balloon dilation and fluoroscopy.
31637ADD-ONStent placement, additional stentUsed with 31636. Placement of each additional tracheal or bronchial stent. Includes balloon dilation.
31638Stent revision or removalDiagnostic and therapeutic bronchoscopy with revision or removal of previously placed tracheal or bronchial stent.
31899Unlisted bronchoscopy procedureUse for novel/emerging procedures, i.e. electrocautery closure of a tracheoesophageal fistula.
Common Modifiers
-22
Increased Procedural Services
Use this modifier when the procedure required substantially greater work (patient complexity, time, cognitive/physical effort). This requires documentation for justification, but it can lead to an additional 25-50% reimbursement.
-80
Assistant Physician
Use this modifier if a second physician was necessary and assisted with the procedure. The second physician should separately bill the same procedure code with modifier 80. It is reimbursed at 16%. The operative report should specifically state whether the assistant was present and, if so, the assistant's contribution to the procedure/medical necessity of the assistant's presence.
-AS
Assistant APP
Use this modifier if an APP (PA, NP) was necessary and assisted with the procedure. The APP should separately bill the same procedure code with modifier AS. It is reimbursed at 13.6%. The operative report should specifically state whether the assistant was present and, if so, the assistant's contribution to the procedure/medical necessity of the assistant's presence.
-XS
Separate Structure
Use this modifier when a procedure is performed on a separate structure. For example, it can be added to 31654 if radial EBUS was done on a separate structure for biopsy while EBUS-TBNA (31653) was also done.
-25
E/M Billing + Bronchoscopy
Use this modifier when performing an E&M (evaluation and management, i.e. consult/progress note) on a patient during the same day of a procedure, unless the E&M service is only for the procedure. For example, if you are providing an inpatient consult with recommendations outside the bronchoscopy, use this modifier to ensure payment for both the procedure and E&M note.
-76
Repeat Procedure (Same Physician)
Use this modifier if the same procedure is repeated on the same day by the same provider (such as repeat bronchoscopy to evaluate the airway, endotracheal tube, therapeutic aspiration, etc.).
-51
Multiple Procedures
Use this modifier to indicate additional distinct procedures. This is usually auto-applied, but you can use it to specify which are secondary procedures with lower RVU since they are reimbursed at 50%. Bronch add-ons are exempt.
Key Billing Rules & Tips
  • →Bill for all procedures: Ensure all components of your procedure all billed for. For example, if you do cEBUS with TBNA and BAL, bill the base code (31652/31653) plus add-ons (31624-51 for BAL).
  • →EBUS 31652 vs 31653: 31652 = 1–2 stations; 31653 = 3+ stations. Never bill both together.
  • →22 Modifier: It may help to have a dedicated part of the OP note reflect why the procedure had increased complexity (patient status), or why it took additional time and effort.
  • →51 Modifier: This is assumed in many procedures and excluded in add-ons, but it may help indicate which is the secondary procedure to the payer.
Example Clinical Coding Scenarios
Case 1 · Peripheral Lesion + Adenopathy
pEBUS/CT nav + TBNA/cryobiopsy + cEBUS-TBNA (3 stations)
15-year-old male with RUL mass and mediastinal adenopathy. CT navigation and radial EBUS used to sample (TBNA) a peripheral lesion and then perform a cryobiopsy. Linear EBUS then used subsequently to sample stations 4R, 7, and 10R.
31653316543162831627-XS
Use -XS on 31654 to distinguish a different structure sampled from central EBUS. Consider -22 on 31653 if the procedure required additional time or effort due to complexity and/or patient status.
Case 3 · PICU: PNA + Lobar Collapse
Therapeutic Bronchoscopy + BAL
4 year-old female Intubated in the PICU with suspected bacterial pneumonia and lobar collapse seen on imaging due to mucus plugging. BAL done for diagnostics and significant therapeutic aspiration of secretions.
3162431645-51
31624 is the main procedural code. 31645 can be added (with -51 modifier to indicate it is a secondary procedure) for the significant therapeutic aspiration of mucus. OP note must reflect this.
Case 4 · Persistent Air Leak
EBV placement (x3)
8-year-old male with necrotizing pneumonia of the LLL complicated by persistent air leak. Balloon occlusion isolated air leak to LLL. Two valves placed in the LLL (superior segment and basilar trunk).
31647-22
31647 covers valve placement within a single lobe, regardless of the number of valves deployed. Balloon occlusion and sizing included. -22 added for time and complexity and critical illness of patient (documented in OP note). Consider adding 31624-51 if a BAL was also done during the procedure.
Case 5 · Airway Tumor
Tumor Biopsy + Debulking
17-year-old female with a large endobronchial tumor obstructing the right mainstem bronchus. Endobrochial biopsy done for diagnosis (cryobiopsy). Cryotherapy used for debulking and recannalization of the airway.
3164131625-22-51
31641 used for destruction of tumor/relief of stenosis. -22 modifier added (with appropriate documentation) given the increased complexity, critical status of the airway, bleeding, and time necessary. 31625 added for the endobronchial biopsy with -51 modifier indicating it was a secondary procedure.
⚠ Note Educational reference only. Always verify codes with current guidelines. AJ takes no responsibility for its use. Codes subject to change and may vary by payer.
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