Summary & Overview
CPT 31645: Bronchoscopic Aspiration of Tracheobronchial Tree
Headline: CPT code 31645 defines bronchoscopic aspiration of the tracheobronchial tree, a commonly used procedure to remove fluid from the airways. Lead: CPT code 31645 captures bronchoscopy with aspiration of the trachea, bronchi, and bronchioles using a rigid or flexible bronchoscope, with optional fluoroscopic guidance; it is relevant to pulmonary, critical care and thoracic procedural workflows nationwide.
CPT code 31645 represents a diagnostic and therapeutic airway procedure used to clear or sample fluid from the tracheobronchial tree. It is clinically important for management of airway secretions, evaluation of suspected infection or bleeding, and for patients with impaired airway clearance. Nationally, the code is utilized across inpatient, outpatient hospital, and ambulatory surgery settings.
Key payers typically referenced in coverage and payment discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is performed, common sites of service, and the payer landscape addressed in this publication. The report also outlines benchmarking and payment considerations, policy updates relevant to bronchoscopy services, and operational implications for facilities that offer airway procedures.
This summary provides a concise reference for coding staff, clinicians, and policy analysts seeking a national view of CPT code 31645 and its role in pulmonary procedural care.
Billing Code Overview
CPT code 31645 describes bronchoscopic aspiration of the tracheobronchial tree using a rigid or flexible bronchoscope to view the airways and aspirate fluid from the trachea, bronchi, and bronchioles. The procedure may be performed with or without fluoroscopic guidance.
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Service type: Bronchoscopic airway aspiration (diagnostic/therapeutic airway clearance)
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Typical site of service: Hospital inpatient or outpatient departments and ambulatory surgery centers; may also be performed in procedural suites where bronchoscopy services are provided.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to the hospital with acute hypoxemic respiratory failure and copious purulent secretions with fever and leukocytosis. Chest radiograph shows a lobar consolidation and an endotracheal tube in place following intubation for respiratory failure. The pulmonary team performs a bronchoscopic airway suction/aspiration using a flexible bronchoscope to clear secretions and obtain lower respiratory tract samples. The procedure may occur in the intensive care unit (ICU) at bedside or in an operating room (OR) or bronchoscopy suite under monitored anesthesia care. Typical clinical workflow: pre-procedure review of indications and coagulation status, informed consent, topical/local anesthetic and sedation (or general anesthesia if intubated), insertion of a rigid or flexible bronchoscope, visual inspection of the tracheobronchial tree, suction aspiration of secretions or fluids from targeted airways, optional fluoroscopic guidance if indicated, collection of samples for culture or cytology, hemostasis and post-procedure monitoring with documentation of findings and any immediate complications.
Coding Specifications
- Note: Selected modifiers focus on those most applicable to bronchoscopic suction/aspiration procedures.
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation or professional portion separate from technical services (rare for this procedure unless facility bills technical component). |