AJ's Pediatric Interventional Pulmonology Billing Reference
Quick Reference on Pediatric Bronchoscopy Billing
CPT ReferenceVerify coverage & payer-specific rules
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Basic & Diagnostic Bronchoscopy
31622Bronchoscopy, diagnosticFlexible or rigid; with or without cell washing — base code, no biopsy
31623Bronchoscopy + brushingDiagnostic with brushing(s) for cell studies
31624ADD-ONBronchoscopy + BALBronchoalveolar lavage — use once per session regardless of lobes
31625Bronchoscopy + biopsy(ies)Forceps biopsy of bronchial or endobronchial lesion(s)
31626Bronchoscopy + fiducial markersPlacement of fiducial markers for radiotherapy guidance
31627ADD-ONComputer-assisted navigationAdd-on: navigational component used with bronchoscopic procedure(s)
31628Bronchoscopy + TBBx, single lobeTransbronchial lung biopsy, one lobe; each additional lobe → 31632
31629Bronchoscopy + TBNATBNA of tracheal/bronchial lesion or nodule
31632ADD-ONTBBx, each additional lobeAdd-on: used with 31628; bill one unit per additional lobe biopsied
31633ADD-ONTBNA, each additional lobeAdd-on: used with 31629; each additional lobe targeted
31640Bronchoscopy + tumor excisionWith excision of tumor (mechanical, laser, APC, or electrocautery)
31641Bronchoscopy + stent placementTracheal/bronchial stent placement (silicone or metal)
Advanced Interventional Pulmonology
31652EBUS-TBNA, 1–2 stationsEndobronchial ultrasound-guided TBNA; 1–2 mediastinal/hilar lymph node stations
31653EBUS-TBNA, 3+ stationsThree or more mediastinal/hilar stations — use instead of, not in addition to, 31652
31654ADD-ONPeripheral EBUS (radial probe)Add-on: peripheral lung lesion — use with 31628 or 31629; distinct from 31652/31653
31660Bronchial thermoplasty, 1 lobeSevere persistent asthma; RF energy applied to airway smooth muscle
31661ADD-ONBronchial thermoplasty, each add'l lobeAdd-on: used with 31660; typically 3 sessions: RLL → LLL → both UL
31647Airway valve placement, 1st bronchusEndobronchial one-way valve (Zephyr/Spiration) for LVRS effect in severe emphysema
31648Airway valve removal, 1st bronchusRemoval of endobronchial valve(s) — first bronchus
31649ADD-ONAirway valve removal, each add'l bronchusAdd-on: used with 31648
31645Bronchoscopy + therapeutic aspirationFirst aspiration of secretions/mucus plug (e.g., ICU lobar collapse)
31646ADD-ONTherapeutic aspiration, each add'l lobeAdd-on: used with 31645
31899Unlisted bronchoscopy procedureUse for novel/emerging procedures; requires medical record and operative note
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.
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.
⚠ EEducational reference only. Always verify codes with current guidelines. AJ takes no responsibility for its use. Codes subject to change.