IP CPT Billing Cheat Sheet

Basic Flexible Bronchoscopy

31622	BronchoscopyDiagnostic bronchoscopy for evaluation of the airways.
31623	Bronchoscopy + brushingDiagnostic bronchoscopy with brushing(s) for cell studies (such as PCD evaluation).
31624	Bronchoscopy + BALDiagnostic bronchoscopy with bronchoalveolar lavage.
31635	Bronchoscopy + 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).
31502	Tracheostomy tube changeTracheostomy tube change; consider modifier 51 to ensure reporting as a secondary procedure.
31645	Bronchoscopy + aspiration, initialTherapeutic bronchoscopy with aspiration of secretions/mucus; initial.
31646	Bronchoscopy + aspiration, subsequentTherapeutic bronchoscopy with aspiration of secretion/mucus; subsequent. Used during same hospital stay.
31575	Flexible 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

31625	EBBxDiagnostic bronchoscopy with endobronchial biopsy(s).
31628	TBBx, single lobeDiagnostic bronchoscopy with transbronchial lung biopsy, one/first lobe. Additional lobes should include 31632.
31632ADD-ON	TBBx, each additional lobeUsed with 31628; bill one unit per additional lobe biopsied.
31629	TBNADiagnostic bronchoscopy with transbronchial needle aspiration (TBNA). Not used for lymph node biopsies (see 31652/31653).
31633ADD-ON	TBNA, each additional lobeUsed with 31629; bill one unit per additional lobe targeted
31654ADD-ON	Peripheral EBUS (radial probe)Used with 31628 or 31629 to indicate use of radial/peripheral EBUS
31627ADD-ON	Computer-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.
31652	Central (linear) EBUS-TBNA, 1–2 stationsDiagnostic bronchoscopy with endobronchial ultrasound-guided TBNA; 1–2 mediastinal/hilar lymph node stations.
31653	Central (linear) EBUS-TBNA, 3+ stationsDiagnostic bronchoscopy with endobronchial ultrasound-guided TBNA; 3+ mediastinal/hilar lymph node stations. Used instead of 31652.
31634	Balloon 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).
31647	EBV 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-ON	EBV placement, each additional lobeUsed with 31647. EBV placement, each additional lobe. Includes balloon occlusion and sizing. May include multiple valves in the same lobe.
31648	EBV 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-ON	EBV removal, each additional lobeUsed with 31648. EBV removal, each additional lobe. May include removal of multiple valves in the same lobe.
31630	Balloon dilationDiagnostic and therapeutic bronchoscopy with tracheal and/or bronchial dilation.
32997	Whole lung lavageDiagnostic and therapeutic bronchoscopy with whole lung lavage.
31641	Tumor 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).
31636	Stent placementDiagnostic and therapeutic bronchoscopy with placement of tracheal or bronchial stent. Includes balloon dilation and fluoroscopy.
31637ADD-ON	Stent placement, additional stentUsed with 31636. Placement of each additional tracheal or bronchial stent. Includes balloon dilation.
31638	Stent revision or removalDiagnostic and therapeutic bronchoscopy with revision or removal of previously placed tracheal or bronchial stent.

Common Modifiers

-22

Increased Procedural Services

Substantially greater work than typically required. Requires documentation; expect payer review. Reimbursement increase not guaranteed.

-51

Multiple Procedures

Multiple distinct procedures same session/same provider. Usually auto-applied; secondary codes reimbursed at 50%. Many bronch add-ons are -51 exempt.

-59

Distinct Procedural Service

Indicates procedure is distinct/independent from another on the same day. Use when NCCI edits bundle codes that should be separately billable.

-76

Repeat Procedure, Same Physician

Same procedure repeated on same day. Requires documentation of medical necessity.

-80

Assistant Surgeon

Physician assistant at surgery. Reimbursed at ~16% of allowed amount. Requires documentation that assistant was medically necessary.

-XS

Separate Structure

Subset of -59; procedure performed on a separate organ/structure. Preferred by CMS over -59 when applicable.

Assistant (APP)

An APP assistant.

Separate surgeon

Another physician who reports their own distinct part.

Bilateral

When done on both sides of the body

Key Billing Rules & Tips

▸One bronchoscopy base per session: Bill only one base bronch code per operative session; stack add-on codes.
▸EBUS 31652 vs 31653: 31652 = 1–2 stations; 31653 = 3+ stations. Never bill both together.
▸Cryobiopsy: Use 31628 (TBBx) or 31899 (unlisted) depending on payer.
▸ROSE: Pathologist bills 88333/88334 separately — not billable by pulmonologist.
▸Navigation (31627): Billable separately; document navigation system used in note.
▸Imaging guidance: When bundled into code (32555, 32557), do NOT separately bill 76942.
▸-XS vs -59: CMS prefers granular X-modifiers. Use -XS for peripheral EBUS alongside central EBUS.
▸Same-day E/M: Append -25 to a separately identifiable E/M billed same day as a procedure.
▸Global period: Most bronch procedures have 0-day global. Post-op E/M billable same day with -24/-25.
▸Medical necessity: Link ICD-10 codes tightly to CPT. For -22, attach operative note excerpt to claim.

Example Clinical Coding Scenarios

Case 1 · Peripheral Lesion + Adenopathy

EBUS with Peripheral Lesion Sampling

Patient with RUL mass and mediastinal adenopathy. EBUS-TBNA performed at stations 4R, 7, and 10R (3 stations). Radial probe EBUS + TBBx performed for the RUL lesion. Navigational bronchoscopy used.

31653316543162831627-XS on 31654

Use -XS on 31654 to distinguish from central EBUS. Do NOT also bill 31652.

Case 2 · Malignant Pleural Effusion

Medical Thoracoscopy + Talc Pleurodesis

Recurrent malignant pleural effusion. Medical thoracoscopy performed, parietal pleural biopsies taken, talc poudrage administered.

3260132560

32601 covers the thoracoscopy + biopsy. 32560 separately billable for the talc instillation/pleurodesis. ICD-10: J91.0.

Case 3 · ICU Lobar Collapse

Therapeutic Bronchoscopy + BAL, Two Lobes

Intubated ICU patient with RLL and RML lobar collapse from mucus plugging. Therapeutic aspiration of both lobes; BAL performed in RLL.

316453164631624-22

31645 = first lobe; 31646 add-on for second lobe; 31624 for BAL. Attach op-note excerpt supporting -22.

Case 4 · Emphysema / LVRS Alternative

Endobronchial Valve Placement, 3 Valves

Severe heterogeneous emphysema, LUL target. Three Zephyr valves placed in separate segmental bronchi of the LUL.

31647

31647 covers placement regardless of number of valves in one session. Bill once per session. Confirm payer prior authorization.

Case 5 · Airway Obstruction

Tumor Debulking + Stent Placement

Endobronchial squamous cell carcinoma causing RMB obstruction. Mechanical debulking and APC applied to tumor, followed by silicone Y-stent placement.

3164031641-22

31640 for tumor excision; 31641 for stent. Both billable together — distinct components.

Case 6 · Severe Asthma

Bronchial Thermoplasty — Session 1 of 3

Severe persistent asthma, inadequately controlled on biologic therapy. First session targeting RLL only.

31660

Bill 31660 once for single-lobe sessions. Add 31661 for two-lobe sessions. Three separate sessions expected. Prior auth essential.