CPT 31625: Bronchial or Endobronchial Biopsy via Bronchoscopy
CPT code 31625 designates bronchoscopic biopsy performed with a rigid or flexible bronchoscope to obtain one or more bronchial or endobronchial tissue samples, optionally using fluoroscopic guidance. This diagnostic procedure is central to evaluating suspected airway and parenchymal lung disease, influencing diagnosis, staging, and subsequent management. Nationally, bronchoscopic biopsy volumes and coverage policies affect access to tissue diagnosis for lung cancer, infectious and inflammatory lung diseases.
Key payers considered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical role of 31625, common care settings and service type, typical payer coverage considerations, and coding relationships.
The report provides: benchmarks and utilization context where available; a summary of payer coverage patterns and prior authorization trends; and clinical context explaining when bronchoscopic biopsy is performed and how it fits into diagnostic pathways for pulmonary disease. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 31625 describes the use of a rigid or flexible bronchoscope to obtain one or more bronchial or endobronchial biopsies for the diagnosis of lung disease. The procedure may be performed with fluoroscopic guidance.
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Service type: Diagnostic bronchoscopic biopsy
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Typical site of service: Hospital outpatient department, ambulatory surgery center, or inpatient operating/procedure room, depending on clinical setting and patient status.
Clinical & Coding Specifications
Clinical Context
A 62-year-old current smoker with a 40-pack-year history presents with progressive cough, hemoptysis, and an indeterminate 2.5 cm right upper-lobe pulmonary nodule on chest CT. The pulmonologist schedules a diagnostic bronchoscopy with endobronchial biopsy to obtain tissue for histopathology and culture. The procedure is performed in an outpatient endoscopy suite under moderate sedation with either a flexible bronchoscope or a rigid bronchoscope if indicated. Fluoroscopic guidance is available and used when sampling peripheral lesions. The workflow includes pre-procedure consent and history review, airway assessment, topical anesthesia and sedation, bronchoscope insertion, targeted visualization of endobronchial lesions, biopsy sampling (one or more specimens), hemostasis as needed, specimen labeling and transport to pathology, post-anesthesia recovery, and discharge with follow-up for pathology results and further oncologic or infectious workup.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of procedure | Use when a distinct evaluation and management encounter is performed before bronchoscopy and is documented separately. |
| 52 | Reduced services | Use when the bronchoscopy/biopsy is partially reduced or not completed as originally intended.
| 53 | Discontinued procedure | Use if the bronchoscopy with biopsy is started but discontinued due to patient instability or unexpected findings.
| 59 | Distinct procedural service | Use when a separate, unrelated procedure is performed on the same day that is not normally bundled with the bronchoscopy.
| 62 | Two surgeons | Use when two surgeons of the same specialty jointly perform the bronchoscopy/biopsy in a substantive way.
| 66 | Surgical team | Use when a surgical team procedure is billed under team rules (rare for bronchoscopy).
| 76 | Repeat procedure by same physician | Use when the same provider repeats bronchoscopy/biopsy during the postoperative period for the same patient (if applicable).
| 77 | Repeat procedure by another physician | Use when another provider repeats the bronchoscopy/biopsy for the same patient on the same day or later.
| 78 | Return to OR for a related procedure during the global period | Use when the patient returns to an operating/procedure room for a related bronchoscopic intervention during the global period.
| 79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period.
| 26 | Professional component | Use when only the physician interpretation/professional portion of a service is billed separately (rare for bronchoscopy alone).
| TC | Technical component | Use when only the technical component (facility or equipment) is billed separately, e.g., fluoroscopy equipment fees.
| 59 | Distinct procedural service | Use when separate anatomic site or separate condition justifies an additional procedure (included above for emphasis).
| QK | Medical direction of two to four qualified individuals | Use when the physician medically directs CRNAs in the provision of anesthesia for the procedure.
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RC0000X | Pulmonary Disease | Pulmonologists most commonly perform bronchoscopy with endobronchial biopsy. |
| 207RH0000X | Thoracic Surgery | Thoracic surgeons perform bronchoscopic procedures, especially rigid bronchoscopy or complex airway interventions.
| 207K00000X | Critical Care Medicine | Intensivists may perform bronchoscopic biopsies in critically ill inpatients.
| 208D00000X | Anesthesiology | Anesthesiologists provide sedation or general anesthesia for procedures requiring deeper airway control.
| 207P00000X | Internal Medicine | Hospitalists or general internists with procedural training may assist or perform in some settings.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C34.1 | Malignant neoplasm of upper lobe, bronchus or lung | Suspected primary lung cancer presenting as a pulmonary nodule or endobronchial mass prompting biopsy. |
| R09.3 | Abnormal sputum | Hemoptysis or abnormal sputum may prompt bronchoscopic evaluation and biopsy.
| R05 | Cough | Persistent unexplained cough leading to bronchoscopy to evaluate airway pathology.
| J98.4 | Bronchiectasis | Endobronchial biopsies may be performed if focal lesions or suspected superimposed infection/malignancy are present.
| A15.0 | Tuberculosis of lung | When endobronchial TB or suspected mycobacterial infection requires tissue diagnosis via bronchoscopy.
| J84.10 | Pulmonary fibrosis, unspecified | Transbronchial or endobronchial biopsies are sometimes used in interstitial lung disease workups (note: surgical lung biopsy may be required for definitive diagnosis).
| J95.2 | Postprocedural pulmonary complication | Coded when complications from bronchoscopy/biopsy occur (e.g., pneumothorax, bleeding) and require coding.
| R91.8 | Other nonspecific abnormal finding of lung field | Indeterminate imaging findings prompting diagnostic bronchoscopic biopsy.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
31622 | Bronchoscopy, rigid or flexible, with diagnostic bronchoscopy including cell washing, with or without obtaining specimens by brushing or washings | Performed when additional diagnostic sampling (washings, brushings) is obtained during the same session; may be billed in conjunction depending on documentation and bundling rules. |
| 31628 | Bronchoscopy, rigid or flexible, with transbronchial lung biopsy(s) | Used when transbronchial biopsies of peripheral lung parenchyma (vs. endobronchial/bronchial biopsies) are obtained in addition to or instead of endobronchial biopsies.
| 31635 | Bronchoscopy with endobronchial or transbronchial biopsy with bronchial thermoplasty or other therapeutic interventions | Coded when therapeutic airway interventions are performed along with diagnostic biopsies.
| 76000 | Fluoroscopy, up to one hour physician or other qualified health care professional time | Coded for fluoroscopic guidance if separately reportable in the facility's billing structure; often the technical component is billed by the facility.
| 99152 | Moderate sedation services provided by the same physician performing the procedure (initial 15 minutes) | Used when the bronchoscopist personally performs moderate sedation and documents time and medical direction requirements; otherwise anesthesia codes may apply.
| 00740 | Anesthesia for bronchoscopy; complicated | Used when general anesthesia or complex anesthetic care is required for bronchoscopy with biopsy; billed by anesthesia provider.