Summary & Overview
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.
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.