CPT 31623: Bronchoscopic Brushing for Lung Tissue Sampling
CPT code 31623 represents bronchoscopic brushing or protected brushing using a rigid or flexible bronchoscope to collect cytologic or pathologic samples from lung tissue or lesions; fluoroscopic guidance may be used. This code is important nationally because bronchoscopic sampling is a core diagnostic tool in pulmonary medicine for evaluating masses, lesions, and diffuse lung disease. Accurate coding influences clinical documentation, facility and professional billing, and downstream quality measurement tied to diagnostic pathways.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 31623 is used, typical settings where the service is provided, and how this code fits into broader bronchoscopic diagnostic workflows. The publication summarizes common modifiers and related administrative considerations, highlights benchmarks and payer coverage patterns where available, and points to policy and coding nuances that affect billing and reimbursement. Data not available in the input for specific payer fee schedules, ICD-10 pairings, and provider taxonomy mappings is noted as unavailable. The emphasis is national in scope and aimed at coding professionals, hospital billing teams, and clinical leaders seeking a clear, practical reference for CPT code 31623.
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Billing Code Overview
CPT code 31623 describes bronchoscopic brushing or protected brushing performed with a rigid or flexible bronchoscope. In this procedure the provider uses a soft brush to gently wipe lung tissue or to scrape a lesion to obtain cytologic or pathologic material. The procedure may be performed with fluoroscopic guidance when needed.
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Service type: Bronchoscopic diagnostic procedure (airway endoscopy with brushing)
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Typical site of service: Hospital inpatient, hospital outpatient department, or ambulatory surgical center; may also be performed in endoscopy suites or interventional pulmonology clinics depending on facility capabilities.
Clinical & Coding Specifications
Clinical Context
A 64-year-old current or former smoker presents with persistent hemoptysis and a focal, suspicious peripheral pulmonary nodule identified on chest CT. Pulmonary medicine or thoracic surgery schedules a bronchoscopy with brushings using a flexible bronchoscope under conscious sedation or general anesthesia. In the procedure suite or endoscopy unit the provider performs airway inspection, identifies an endobronchial lesion or area of abnormal mucosa, and obtains brushings with a soft cytology brush for cytologic analysis. Fluoroscopic guidance may be used to localize peripheral lesions. Samples are placed in cytology medium and sent to pathology. Typical site of service is an outpatient endoscopy or ambulatory surgery center, hospital outpatient department, or inpatient operating room for patients already admitted. The service type is diagnostic bronchoscopic sampling (bronchoscopic brushing/protected brushing) performed by a pulmonologist or thoracic surgeon for cytologic evaluation of suspected malignancy, infection, or unexplained pulmonary infiltrate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician professional portion is reported separately from the technical component (rare for bronchoscopy imaging). |
50 | Bilateral procedure | Use if documentation supports bilateral procedures when applicable (not common for bronchial brushings). |
51 | Multiple procedures | Use when multiple unrelated procedures are reported on the same date by the same provider. |
52 | Reduced services | Use when the service was partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to patient-related or intra-procedural issues. |
59 | Distinct procedural service | Use to indicate a separate and distinct service from other procedures on the same date (e.g., separate diagnostic sampling). |
62 | Two surgeons | Use when two surgeons work together as primary surgeons (rare for bronchoscopy). |
66 | Surgical team | Use when a surgical team is documented for complex cases. |
78 | Return to OR for related procedure during postoperative period | Use if the patient returns to the operating room for a related procedure shortly after the index procedure. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period. |
73 | Discontinued outpatient hospital/ASC procedure prior to anesthesia administration | Use when the outpatient bronchoscopy is cancelled before anesthesia begins. |
76 | Repeat procedure by same physician | Use when the same procedure is repeated by the same physician on the same day (if applicable). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RP0500X | Pulmonary Disease | Pulmonologists commonly perform diagnostic bronchoscopies and brushings. |
| 2084P0800X | Thoracic Surgery | Thoracic surgeons perform bronchoscopic procedures in perioperative or complex cases. |
| 207L00000X | Allergy & Immunology (Pulmonology-focused) | Some interventional pulmonology providers with this taxonomy may perform advanced bronchoscopic sampling. |
| 363LP0800X | Interventional Pulmonology | Subspecialists performing advanced bronchoscopy including guided brushings and sampling. |
| 207K00000X | Internal Medicine (Hospitalists performing bedside bronchoscopies in some centers) | Hospital-based internists may perform bronchoscopic sampling in certain institutions. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
R04.2 | Hemoptysis | Hemoptysis is a common indication for bronchoscopic evaluation and cytologic brushings to identify source or malignancy. |
C34.90 | Malignant neoplasm of unspecified bronchus or lung, unspecified side | Suspected lung cancer often prompts bronchoscopy with brushings for cytologic diagnosis. |
J84.10 | Pulmonary fibrosis, unspecified | Diffuse parenchymal lung disease may require bronchoscopic sampling to exclude alternative etiologies or infection. |
J98.4 | Other disorders of lung, not elsewhere classified | Used for atypical airway abnormalities where cytology may help clarify etiology. |
B38.4 | Coccidioidomycosis of lung | Infectious etiologies may be diagnosed or suspected and brushings can provide microbiology/cytology specimens. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
31622 | Bronchoscopy, rigid or flexible, diagnostic, with bronchial washing(s) (separate procedure) | Performed for fluid sampling; bronchial washings may be obtained in addition to or instead of brushings in the same session. |
31624 | Bronchoscopy, flexible or rigid, with bronchial or transbronchial biopsy(s) (single or multiple) | Biopsy is frequently performed alongside brushings when tissue diagnosis is required for suspected malignancy. |
31628 | Bronchoscopy, rigid or flexible, with transbronchial lung biopsy; including fluoroscopic guidance, when performed | Relevant when sampling of parenchymal lung beyond airways is required in the same procedure session. |
31642 | Bronchoscopy, rigid or flexible, with placement of fiducial markers | May be performed in the same session for localization prior to radiation therapy for confirmed malignancy. |
31635 | Bronchoscopy, rigid or flexible, with endobronchial biopsy, with or without brushings | Endobronchial biopsy is commonly combined with brushings to increase diagnostic yield. |