CPT 31628: Transbronchial Biopsy via Bronchoscopy, Single Lobe
CPT code 31628 denotes a transbronchial biopsy performed with a rigid or flexible bronchoscope targeting one lobe of the lung, with optional fluoroscopic guidance. Nationally, this code captures bronchoscopic sampling of peripheral or parenchymal lung tissue for diagnostic evaluation, often used in workups for interstitial lung disease, suspected malignancy, or unexplained pulmonary pathology. Accurate coding affects clinical documentation, reimbursement, and tracking of bronchoscopic diagnostic procedures across care settings.
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 intent and typical sites of service, standard billing considerations tied to the procedure type, and a summary of common modifiers encountered in practice. The publication also addresses benchmark metrics and policy context where available, helping stakeholders understand coding consistency, utilization patterns, and potential documentation drivers.
This national summary is intended for clinical coders, revenue officers, pulmonologists, and health policy analysts seeking a clear, practice-focused reference for CPT code 31628, its clinical role, and the payer environment relevant to bronchoscopic transbronchial biopsy services.
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Billing Code Overview
CPT code 31628 describes a procedure in which a provider uses a rigid or flexible bronchoscope to obtain one or more transbronchial biopsies from a single lobe of the lung. The procedure may be performed with fluoroscopic guidance.
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Service type: Transbronchial lung biopsy via bronchoscopy
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Typical site of service: Hospital outpatient department or ambulatory surgical center, performed in a bronchoscopy suite or OR setting
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a 40-pack-year smoking history and progressive unexplained hemoptysis and a new peripheral lung nodule on chest CT is referred for diagnostic bronchoscopy. The pulmonologist schedules a transbronchial biopsy using a flexible bronchoscope with possible fluoroscopic guidance to obtain tissue from a single lobe for histology and microbiology. Pre-procedure workflow includes informed consent, coagulation assessment, withholding antiplatelet/anticoagulant medications as indicated, pre-procedure imaging review, and anesthesia planning (moderate sedation or general anesthesia). In the procedure suite (hospital outpatient department, ambulatory surgery center, or inpatient operating room), the provider performs airway inspection, advances the bronchoscope into the target lobe, and obtains multiple transbronchial biopsy specimens. Fluoroscopy may be used to guide sampling and reduce pneumothorax risk. Post-procedure monitoring includes observation for bleeding, pneumothorax assessment with chest radiograph if clinically indicated, recovery from sedation, and pathology/clinical follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a separate E/M visit is documented on the same day as the transbronchial biopsy (e.g., new pre-procedure evaluation) |
26 | Professional component | Use when billing only the physician's professional interpretation component of an associated imaging or fluoroscopy service |
50 | Bilateral procedure | Not typically used for 31628 (single lobe biopsy); include only if documentation supports bilateral separate lobar biopsies (rare) |
51 | Multiple procedures | Use when multiple distinct procedures are performed in the same session in addition to the transbronchial biopsy |
52 | Reduced services | Use when the procedure is started but not completed or is partially reduced for documented reasons |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances after anesthesia induction |
59 | Distinct procedural service | Use to indicate a separate and distinct service when another procedure or service might be bundled with bronchoscopy-related work |
62 | Two surgeons | Use when two surgeons with distinct roles perform the procedure (uncommon for bronchoscopic biopsy) |
73 | Discontinued outpatient procedure prior to anesthesia | Use when the outpatient procedure is discontinued before anesthesia is given |
74 | Discontinued outpatient procedure after anesthesia | Use when the outpatient procedure is discontinued after anesthesia induction |
78 | Unplanned return to the operating/procedure room by same physician following initial procedure for a related procedure during the postoperative period | Use when an immediate complication requires return to the procedure room (e.g., control of bleeding) |
80 | Assistant surgeon | Use when a surgical assistant is documented and required for the case |
26 | Professional component | See above (included because fluoroscopic imaging may have separate professional component billing) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 2084P0800X | Pulmonary Disease | Pulmonologists commonly perform bronchoscopic transbronchial biopsies |
| 207RP1001X | Thoracic Surgery | Thoracic surgeons may perform rigid bronchoscopic biopsies or supervise complex airway procedures |
| 207RC0000X | Interventional Pulmonology | Interventional pulmonologists perform advanced bronchoscopic tissue sampling often with fluoroscopic guidance |
| 2080P0207X | Critical Care Medicine | Intensivists may perform or assist with bronchoscopic biopsies in critically ill inpatients |
| 207L00000X | Otolaryngology (ENT) | ENT physicians occasionally perform rigid bronchoscopy for airway or proximal tracheobronchial lesions |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J98.4 | Other disorders of lung | General category for unspecified lung pathology where tissue diagnosis by transbronchial biopsy may be needed |
J84.10 | Pulmonary fibrosis, unspecified | Transbronchial biopsy may be used to obtain tissue for interstitial lung disease evaluation when clinically indicated |
R04.2 | Hemoptysis | Indication for bronchoscopic evaluation and targeted transbronchial biopsy when a focal lesion is identified |
R91.8 | Other nonspecific abnormal finding of lung field | Follow-up of indeterminate pulmonary nodule or mass prompting biopsy |
C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung | Tissue diagnosis required for suspected primary lung malignancy |
A15.0 | Tuberculosis of lung | Transbronchial biopsy can provide tissue or samples for microbiologic/histopathologic diagnosis in selected cases |
J61 | Pneumoconiosis due to asbestos and other mineral fibers | Biopsy may be used when diagnosis is unclear and tissue characterization is necessary |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
31622 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage | Performed before or during bronchoscopy for cytology and microbiology sampling complementary to tissue biopsy |
31623 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy, with forceps (separate from 31628 which is for single lobe) | Alternative code for transbronchial biopsy technique or when multiple lobes/sampling approach differs; code selection depends on specific technique and documentation |
31635 | Bronchoscopy with transbronchial needle aspiration (TBNA) | Performed in the same session when lymph node sampling is required in addition to parenchymal biopsy |
71020 | Radiologic examination, chest; single view, frontal | Often obtained post-procedure to evaluate for pneumothorax after transbronchial biopsy |
94060 | Bronchoscopy, physician interpretation only (pulmonary function testing related codes vary) | Used when only interpretation services are billed separately for associated testing or imaging interpretations |
31628 | Transbronchial biopsy, single lobe | Primary procedure described; included here for reference in workflow |