CPT 31630: Bronchoscopy with Airway Dilation
CPT code 31630 denotes therapeutic bronchoscopy for dilation of tracheal or bronchial stenosis and treatment of tracheobronchial injury. The code covers rigid or flexible bronchoscopy performed to visualize the central airways and restore patency, using techniques such as balloon dilatation; fluoroscopic guidance may be used but is not required. This procedure is clinically important for managing airway obstruction from stenosis, trauma, or other lesions and carries implications for surgical, pulmonary, and interventional teams nationwide.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national view of billing and clinical context relevant to hospitals, ambulatory surgical centers, and endoscopy suites. Readers will find benchmarks for utilization and reimbursement practices, coding and billing considerations tied to procedure components, and clinical context regarding indications and service settings. The report also highlights common modifiers and documentation elements encountered in claims (Data not available in the input for payer-specific rate tables).
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Billing Code Overview
CPT code 31630 describes a bronchoscopic procedure in which a provider performs rigid or flexible bronchoscopy to visualize the trachea and bronchi and to treat central airway narrowing. The procedure typically includes dilation of tracheal or bronchial stenosis using techniques such as balloon dilatation and may address tracheobronchial fracture or other airway injuries. Fluoroscopic guidance may or may not be used.
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Service type: Therapeutic bronchoscopy with airway dilation
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Typical site of service: Hospital operating room or endoscopy suite; may also be performed in ambulatory surgical centers when clinically appropriate
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with a history of prolonged endotracheal intubation presents with progressive dyspnea, stridor, and recurrent episodes of retained secretions. Imaging and flexible bronchoscopy demonstrate a focal tracheal stenosis approximately 2 cm in length with mucosal scarring and inward collapse. The interventional pulmonology team schedules a rigid or flexible bronchoscopy with balloon dilatation under general anesthesia in the operating room. The workflow includes preoperative assessment and consent, anesthesia induction, airway visualization with bronchoscopy, airway dilation (commonly with balloon dilatation), evaluation for airway injury or fracture, hemostasis as needed, possible placement of a temporary stent if dilation is inadequate, and post-procedure recovery with monitoring for airway compromise, bleeding, or respiratory distress. The procedure may use fluoroscopic guidance and concurrent bronchoscopic therapeutic maneuvers. Documentation elements include indication, bronchoscopic findings, dilation technique and size, use of fluoroscopy, complications, and disposition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work or complexity is substantially greater than usual for bronchoscopy with dilation (e.g., extensive scar tissue, prolonged time). |
23 | Unusual anesthesia | When significant anesthesia is administered for a procedure that normally requires local anesthesia only. |
26 | Professional component | When billing only the physician interpretation/technical component is reported separately (rare for this service). |
52 | Reduced services | When the procedure is partially completed or aborted for clinical reasons (limited dilation attempted). |
53 | Discontinued procedure | When the procedure is discontinued due to extenuating circumstances or patient instability. |
59 | Distinct procedural service | When another distinct procedure is performed in a separate anatomic site or session during the same encounter. |
62 | Two surgeons | When two surgeons work together as co-surgeons due to case complexity. |
78 | Return to OR for related procedure during postoperative period | For unplanned return to the operating room for management of a complication of the initial bronchoscopy/dilation. |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated procedure is performed during the postoperative period. |
80 | Assistant surgeon | When an assistant surgeon is required and reported. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services in an ambulatory surgery center | When advanced practice clinician provides the service in the ASC setting where applicable. |
TC | Technical component | When billing only the technical component of services (e.g., equipment or facility fees separated). |
RT | Right side | When a laterality modifier is required by payer for the right-sided airway procedure (used rarely). |
LT | Left side | When a laterality modifier is required by payer for the left-sided airway procedure (used rarely). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RP0500X | Pulmonary Disease | Interventional pulmonologists commonly perform bronchoscopic dilation and airway stenting. |
| 208U00000X | Thoracic Surgery | Thoracic surgeons perform rigid bronchoscopy and complex airway reconstructions. |
| 363LP0808X | Otolaryngology (ENT) | Otolaryngologists manage tracheal stenosis and perform airway dilations and repairs. |
| 207L00000X | Critical Care Medicine | Intensivists may perform bedside bronchoscopic interventions in select settings. |
| 367A00000X | Anesthesiology | Anesthesiologists provide airway management and general anesthesia for the procedure. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J98.2 | Acute bronchospasm | Airflow limitation that may coexist with airway stenosis and require airway evaluation and dilation in severe cases. |
J98.4 | Other disorders of lung | Broad category that can include post-intubation airway complications evaluated during bronchoscopy. |
J95.2 | Tracheostomy malfunction | Complications from tracheostomy that produce tracheal narrowing and may require bronchoscopic dilation. |
T88.4 | Fracture of trachea and bronchi | Direct airway injury that can cause obstruction or stenosis requiring bronchoscopic repair or dilation. |
J95.0 | Postsurgical pulmonary complications, not elsewhere classified | Postoperative airway complications leading to stenosis or obstruction treated with bronchoscopy. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
31622 | Bronchoscopy, flexible or rigid, with insertion of tracheal stent (includes fluoroscopic guidance, when performed) | Performed when dilation alone is insufficient and an airway stent is placed after dilation to maintain patency. |
31628 | Inspection of trachea/bronchi with or without biopsy, rigid or flexible bronchoscopy | Diagnostic airway inspection and biopsy may precede therapeutic dilation to evaluate underlying pathology. |
31635 | Bronchoscopy, rigid or flexible, with ablation of endobronchial tumor, any method | Used when focal tumor contributes to airway narrowing and ablation is performed in the same session. |
31575 | Intubation, endotracheal, emergency; simple | May be required pre- or post-procedure for airway control in unstable patients undergoing bronchoscopy and dilation. |
31637 | Bronchoscopy, with foreign body removal | Occasionally performed if retained foreign material is contributing to obstruction prior to or during dilation. |