Summary & Overview
CPT 31646: Subsequent Bronchoscopy with Aspiration
CPT code 31646 represents a subsequent bronchoscopy with aspiration of the tracheobronchial tree performed after an initial bronchoscopy during the same hospital encounter. It captures procedures where a rigid or flexible bronchoscope is used to visualize the trachea, bronchi, and bronchioles and to aspirate fluid; fluoroscopic guidance may or may not be used. This code matters nationally because bronchoscopy with aspiration is a common diagnostic and therapeutic service for airway management, respiratory infection evaluation, and clearance of secretions in hospitalized patients.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of the code, typical sites of service, and the scope of services it represents. The publication summarizes what stakeholders need to know about coding capture for subsequent bronchoscopy and aspiration during the same visit, presents national benchmarking concepts where applicable, and highlights policy or billing considerations that affect reimbursement and utilization reporting. Data not available in the input will be noted where relevant.
Billing Code Overview
CPT code 31646 describes a subsequent bronchoscopy procedure in which the provider uses a rigid or flexible bronchoscope to visualize the tracheobronchial tree and aspirate fluid from the airways. The procedure may include fluoroscopic guidance but is specifically coded for a repeat bronchoscopy and aspiration performed after an initial bronchoscopy during the same hospital visit.
-
Service type: Subsequent diagnostic/interventional bronchoscopy with aspiration
-
Typical site of service: Hospital inpatient or hospital outpatient setting where bronchoscopic procedures are performed (bronchoscopy suite, operating room, or endoscopy unit)
Clinical & Coding Specifications
Clinical Context
A 68-year-old hospitalized patient with a history of chronic obstructive pulmonary disease (COPD) and recent left lower lobe consolidation develops increasing hypoxia and copious purulent secretions despite antibiotic therapy. The pulmonology service performs an initial flexible bronchoscopy with diagnostic sampling on hospital day 1. Over the next 24–48 hours the patient accumulates additional tracheobronchial secretions with worsening respiratory status; the team documents persistent airway obstruction and decides to perform a subsequent bronchoscopy with therapeutic aspiration to clear secretions and improve ventilation. The procedure is performed in the hospital bronchoscopy suite or the operating room with monitored anesthesia care; fluoroscopic guidance is available but not required. The workflow includes pre-procedure consent and review of coagulation status, airway assessment, brief anesthesia or sedation, flexible bronchoscope insertion, visualization of trachea and bronchi, suctioning/aspiration of secretions, sample collection as indicated, and post-procedure recovery and documentation. The use of 31646 denotes this is a subsequent bronchoscopy with aspiration during the same hospital visit following an earlier bronchoscopy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
76 | Repeat procedure by same physician | Use when the same physician performs a subsequent bronchoscopy and aspiration during the same encounter (distinct from the initial procedure). |