Summary & Overview
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.
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) |