CPT 31633 Transbronchial Needle Aspiration Reimbursement | OpenPayer

Summary & Overview

CPT 31633: Transbronchial Needle Aspiration Biopsy of Additional Lobe

CPT code 31633 is an add-on bronchoscopy procedure code for performing transbronchial needle aspiration (TBNA) biopsies from an additional pulmonary lobe during the same session as TBNA of the trachea, mainstem, or lobar bronchi. It captures supplemental work when the bronchoscopist obtains one or more additional lobe biopsies using a rigid or flexible bronchoscope, with optional fluoroscopic guidance. This code matters nationally because it distinguishes incremental procedural complexity and supports accurate clinical documentation and reimbursement for extended sampling during diagnostic bronchoscopy.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context for using CPT code 31633, typical sites of service where the procedure is provided, and the service type classification. The publication also summarizes common billing considerations and related coding practices relevant to bronchoscopic TBNA procedures. Where available, benchmarking and policy updates that affect national coverage and payment practices are discussed. Data not available in the input is noted explicitly in sections that require it.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare31633CPTBronchoscopyTransbronchial Needle AspirationAdd-on CodePulmonaryInterventional PulmonologyOutpatient Surgery

Billing Code Overview

CPT code 31633 describes an add-on transbronchial needle aspiration (TBNA) biopsy performed with a diagnostic rigid or flexible bronchoscope to obtain one or more biopsies from an additional pulmonary lobe during the same session as TBNA of the trachea, mainstem, or lobar bronchi. The procedure may be performed with fluoroscopic guidance.

Service type: Bronchoscopic transbronchial needle aspiration biopsy (add-on)

Typical site of service: Hospital outpatient department or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 64-year-old patient with a 40-pack-year smoking history presents with a persistent 3-cm peripheral right upper lobe pulmonary nodule seen on chest CT. PET-CT shows focal hypermetabolism in the nodule with no obvious mediastinal uptake. The pulmonologist schedules a diagnostic bronchoscopy under moderate sedation in a procedure suite with fluoroscopic capability to obtain tissue for histopathology.

During the session, the provider performs a diagnostic flexible bronchoscopy with transbronchial needle aspiration (TBNA) of a right main stem/lobar bronchus lesion and then proceeds to obtain one or more additional TBNA biopsies from an additional lobe (right upper lobe) during the same encounter. Fluoroscopic guidance is used to localize the peripheral lesion. Specimens are sent for cytology, microbiology, and molecular testing as indicated. The procedure is documented with findings, number of passes per site, use of fluoroscopy, anesthesia type, and any complications. Billing includes the primary TBNA service and the add‑on 31633 for biopsies obtained from the additional lobe.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when intraoperative work is substantially greater than usual for `31633` (extensive additional sampling, prolonged procedure time).

CPT 31615: Tracheobronchoscopy Through Existing Tracheal Opening

CPT-31632-TRANSBRONCHIAL-BIOPSY-ADD-ON-ADDITIONAL-LOBE

CPT 31632: Transbronchial Biopsy, Additional Lobe

CPT-31630-THERAPEUTIC-BRONCHOSCOPY-AIRWAY-DILATION

CPT 31630: Bronchoscopy with Airway Dilation

CPT-31624-BRONCHIAL-ALVEOLAR-LAVAGE-BRONCHOSCOPY

CPT 31624: Bronchial Alveolar Lavage via Bronchoscopy

CPT-31649-BRONCHOSCOPIC-BRONCHIAL-VALVE-REMOVAL-ADDON

CPT 31649: Bronchoscopic Removal of Additional Lobe Bronchial Valves

CPT-31625-BRONCHIAL-ENDOBRONCHIAL-BIOPSY-BRONCHOSCOPY

CPT 31625: Bronchial or Endobronchial Biopsy via Bronchoscopy

CPT-31634-BRONCHOSCOPIC-BALLOON-OCCLUSION-FOR-AIR-LEAK

CPT 31634: Bronchoscopic Balloon Occlusion for Pulmonary Air Leak

CPT-31629-TRANSBRONCHIAL-NEEDLE-ASPIRATION-BRONCHOSCOPIC-BIOPSY

CPT 31629: Bronchoscopic Transbronchial Needle Aspiration Biopsy

CPT-31636-AIRWAY-STENT-PLACEMENT-BRONCHOSCOPY

CPT 31636: Bronchoscopy with Airway Stent Placement

CPT-31640-BRONCHOSCOPIC-AIRWAY-TUMOR-EXCISION

CPT 31640: Bronchoscopic Airway Tumor Excision

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Taxonomy Code	Specialty	Notes
207RP1000X	Pulmonology	Interventional pulmonologists commonly perform bronchoscopic TBNA and add-on lobar biopsies.
207K00000X	Thoracic Surgery	Thoracic surgeons may perform advanced bronchoscopic procedures in OR settings.
208000000X	Internal Medicine	Pulmonology subspecialists practice within internal medicine and may bill for bronchoscopy.
2084P0800X	Critical Care Medicine	Intensivists with procedural certification may perform bronchoscopic sampling in ICU settings.
207L00000X	Allergy & Immunology	In some settings, allergy/immunology specialists with pulmonary focus may be involved in airway procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.11`	Malignant neoplasm of right upper lobe, bronchus or lung	Primary lung cancer localized to the right upper lobe; TBNA from additional lobe may be needed for diagnosis or staging.
`R91.8`	Other nonspecific abnormal finding of lung field	Indeterminate pulmonary nodule on imaging prompting bronchoscopic biopsy.
`J84.10`	Pulmonary fibrosis, unspecified	Interstitial lung disease where transbronchial biopsies may be performed to obtain tissue for diagnosis.
`J18.9`	Pneumonia, unspecified organism	Persistent or atypical infection requiring bronchoscopic sampling for microbiology.
`D86.89`	Sarcoidosis of other sites	Sarcoidosis involving the lung often requires TBNA of intrathoracic lymph nodes and lobar sampling for diagnosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31622`	Bronchoscopy, with transbronchial needle aspiration; single lobe	Often billed as the primary TBNA service when sampling the trachea, main stem, or lobar bronchus during the same session; `31633` is an add‑on for additional lobe sampling.
`31628`	Bronchoscopy, rigid or flexible, with transbronchial lung biopsy(s), with or without fluoroscopic guidance	May be performed when transbronchial forceps biopsies are required in addition to TBNA sampling; used when tissue from parenchyma (not just nodes/bronchi) is obtained.
`31635`	Bronchoscopy, with transbronchial needle aspiration; each additional lobe beyond initial sampling (note: verify code specifics in payer policy)	Related add‑on code sometimes used in conjunction with `31622`; coding conventions vary by payer—document number of lobes sampled.
`31623`	Bronchoscopy, rigid or flexible, with bronchoalveolar lavage and/or washings	Often performed alongside TBNA to obtain cytology and microbiology specimens from separate lobes or segments.
`99232`	Subsequent hospital care, per day, for the evaluation and management of an established patient	Used for postoperative or inpatient follow-up care after bronchoscopy when medically necessary.

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