CPT 31624: Bronchial Alveolar Lavage via Bronchoscopy
CPT code 31624 represents bronchial alveolar lavage performed via rigid or flexible bronchoscopy, a procedure that uses saline to wash and recover cells from the alveoli for diagnostic or therapeutic purposes. The code is used nationally across hospital and ambulatory settings where bronchoscopy and potential fluoroscopic guidance are available. It captures both diagnostic sampling and lavage-based therapeutic interventions in the lower respiratory tract.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, common modifiers in use, and how payers commonly classify and reimburse bronchoscopy-based lavage services. The summary also orients readers to operational considerations such as equipment needs (rigid or flexible bronchoscope, saline irrigation, optional fluoroscopy) and typical clinical indications for lavage sampling.
This publication provides benchmarks and policy context relevant to billing, coding, and payer coverage for CPT code 31624, plus guidance on documentation elements that support medical necessity. Data not provided in the input are noted where appropriate.
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Billing Code Overview
CPT code 31624 describes a bronchial alveolar lavage performed using a rigid or flexible bronchoscope. The procedure involves instillation and aspiration of saline to wash cells from the alveoli, the air sacs at the ends of the bronchioles. The description notes that fluoroscopic guidance may be used during the procedure.
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Service type: Procedural diagnostic and therapeutic bronchoscopy with bronchial alveolar lavage
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Typical site of service: Hospital inpatient or outpatient setting, ambulatory surgery center, or other facility equipped for bronchoscopy and possible fluoroscopy
Clinical & Coding Specifications
Clinical Context
A 58-year-old man with a history of chronic cough, progressive dyspnea, and diffuse bilateral interstitial opacities on chest CT is referred for bronchoscopic evaluation. The pulmonologist performs bronchoalveolar lavage (BAL) using a flexible bronchoscope to obtain alveolar cellular and microbiologic samples to evaluate for suspected atypical infection, diffuse alveolar hemorrhage, or interstitial lung disease activity. The patient is brought to an outpatient endoscopy suite or hospital bronchoscopy unit, receives local anesthesia with topical lidocaine and moderate sedation (conscious sedation) administered by anesthesia or the bronchoscopist, and is continuously monitored with pulse oximetry, cardiac monitoring, and supplemental oxygen as needed. The bronchoscope is advanced to the targeted segment(s) under direct visualization; sterile saline aliquots are instilled and then aspirated for cytology, microbiology, and inflammatory cell counts. Fluoroscopic guidance may be used when focal peripheral sampling or radiographic localization is required. Post-procedure, the patient is observed in recovery until sedation effects have resolved and discharge criteria are met or admitted if clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when the provider documents a distinct E/M service on the same day as BAL (e.g., new problem evaluation leading to bronchoscopy). |
26 | Professional component | Use when billing only the physician interpretation/professional component separate from the technical component. |
59 | Distinct procedural service | Use when a separate procedure or service performed during the same session is distinct and not bundled with BAL. |
52 | Reduced services | Use when BAL is attempted but substantially reduced or abbreviated per documentation. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to patient condition or complication. |
76 | Repeat procedure by same physician | Use when BAL is repeated later the same day by the same provider. |
77 | Repeat procedure by another physician | Use when BAL is repeated later the same day by a different physician. |
91 | Repeat clinical diagnostic lab test | Use when microbiology or cytology tests obtained from BAL are repeated to confirm results. |
74 | Return to operating/procedural room by same physician after anesthesia administered | Use when patient returns to procedure room for BAL during same anesthetic session. |
22 | Increased procedural services | Use when documentation supports substantially greater complexity or time for BAL than typical. |
52 | Reduced services | Use when procedure is partially performed; documentation must support reduced work. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RP0000X | Pulmonary Disease | Pulmonologists most commonly perform bronchoscopic BAL. |
2084P0800X | Critical Care Medicine | Intensivists perform BAL in ICU patients with respiratory failure. |
207L00000X | Otolaryngology (ENT) | ENT surgeons may perform BAL during airway procedures when indicated. |
208D00000X | Anesthesiology | Anesthesiologists provide sedation or anesthesia support for complex BAL cases. |
363LF0000X | Thoracic Surgery | Thoracic surgeons may perform BAL when combined with operative airway interventions. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J18.9 | Pneumonia, unspecified organism | BAL is used to obtain lower respiratory samples for microbiologic diagnosis in suspected pneumonia. |
J84.10 | Pulmonary fibrosis, unspecified | BAL can assist in evaluating inflammatory cell profiles in interstitial lung disease. |
R05 | Cough | Persistent unexplained cough may prompt bronchoscopy with BAL for diagnostic evaluation. |
R09.02 | Hypoxemia | Unexplained hypoxemia with diffuse radiographic changes may require BAL to identify infection or alveolar hemorrhage. |
J94.2 | Pleuroparenchymal fibroelastosis (if applicable) | BAL may be part of the diagnostic workup for rare interstitial processes (use only when clinically documented). |
J69.0 | Pneumonitis due to food and vomit | BAL can help detect lipid-laden macrophages or pathogens in aspiration-related pneumonitis. |
K74.6 | Other and unspecified cirrhosis of liver (note: systemic disease context) | Included when systemic illness contributes to pulmonary complications evaluated by BAL (use only when clinically indicated). |
D69.3 | Immune thrombocytopenic purpura | BAL may be used to assess alveolar hemorrhage in patients with bleeding diatheses (document indications). |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
31622 | Bronchoscopy, rigid or flexible, diagnostic, with or without cell washing or brushing, with or without protected specimen brush, with or without bronchial lavage (separate from BAL code) | May be reported when diagnostic bronchoscopy with inspection and sampling (other than therapeutic BAL) is performed in addition to lavage; select appropriate code based on procedures documented. |
31623 | Bronchoscopy, rigid or flexible, with bronchoalveolar lavage when performed in combination with other bronchoscopic procedures (alternate coding depending on payer guidance) | Reported for BAL performed during a bronchoscopy session when documentation supports combined services. |
31575 | Laryngoscopy, flexible or rigid, diagnostic, with or without stroboscopy | May be performed before bronchoscopy for upper airway assessment in select patients. |
31641 | Bronchoscopy, with transbronchial lung biopsy(s), single lobe | Performed when tissue biopsy is required in addition to BAL for diagnosis of interstitial lung disease or malignancy. |
94010 | Bronchospasm evaluation (spirometry pre/post) | Pulmonary function testing may be performed peri-procedurally to assess baseline respiratory status. |
99152 | Moderate sedation services provided by same physician performing procedure (initial 15 minutes) | When the bronchoscopist provides moderate sedation rather than anesthesia personnel; bill per payer rules. |