Summary & Overview
CPT 31653: Bronchoscopy with EBUS-Guided Multi-Station Lymph Node Sampling
CPT code 31653 represents bronchoscopic endoscopy with endobronchial ultrasound guidance to sample three or more mediastinal or hilar lymph node stations. This procedure is central to the workup of suspected lung cancer, staging of thoracic malignancy, and diagnosis of mediastinal lymphadenopathy. Nationally, accurate coding for 31653 affects clinical documentation, care pathways, and coverage determinations for advanced diagnostic respiratory procedures.
Major commercial and public payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, service and site-of-care implications, common payer considerations, and benchmarks where available. The content addresses procedure definition, typical clinical indications, and operational settings used for reimbursement and utilization discussions.
The publication provides interpretation of how 31653 is used in practice: what the code denotes clinically, where the service is commonly performed, and which payers commonly manage coverage and prior authorization for bronchoscopic ultrasound-guided lymph node sampling. Data limitations are noted where input information is not available. The goal is to give clinicians, coding professionals, and policy analysts a clear, national-level briefing on CPT code 31653 and its role in thoracic diagnostic care.
Billing Code Overview
CPT code 31653 describes a bronchoscopic procedure in which a provider inserts a rigid or flexible lighted tubular endoscope into the lungs, with or without fluoroscopic guidance, and uses ultrasound guidance in the trachea and/or bronchi to obtain samples from three or more lymph node stations in the hilum or mediastinum.
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Service type: Diagnostic bronchoscopy with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) sampling of three or more lymph node groupings.
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Typical site of service: Hospital outpatient department, ambulatory surgical center, or other procedural settings where endoscopic respiratory procedures and imaging support (fluoroscopy/ultrasound) are available.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a 40-pack-year smoking history presents with a 3.5 cm right upper lobe pulmonary mass on chest CT and ipsilateral hilar and mediastinal lymphadenopathy. The multidisciplinary team plans endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for diagnostic tissue sampling and mediastinal staging. The patient is evaluated pre-procedure for anticoagulation management, informed consent is obtained, and topical and conscious sedation are administered in an outpatient bronchoscopy suite. The provider inserts a flexible, lighted bronchoscope with integrated ultrasound and obtains needle aspirates from three or more nodal stations (for example, right paratracheal, subcarinal, and right hilar) with or without fluoroscopic assistance. Samples are placed in appropriate media for cytology, rapid on-site evaluation (ROSE) if available, and ancillary studies including immunohistochemistry and molecular testing. The patient is monitored post-procedure in recovery for airway compromise, bleeding, or pneumothorax, then discharged with follow-up for results and staging-directed management decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or standard service | Use when service is furnished as the usual, standard procedure without unusual circumstances. |
22 |