CPT 31766 Carina Reconstruction Reimbursement | OpenPayer

Summary & Overview

CPT 31766: Carina Reconstruction After Tumor Resection

CPT code 31766 denotes surgical reconstruction of the carina following tumor removal, a complex thoracic procedure important for restoring central airway integrity after oncologic resection. This code captures reconstructive airway surgery typically performed in inpatient hospital operating rooms by thoracic surgeons and has implications for surgical quality, postoperative care resources, and reimbursement for high-complexity thoracic oncology procedures. Nationally, accurate reporting of this code supports case mix measurement, resource allocation, and benchmarking for centers that treat advanced airway tumors.

Key payers reviewed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis highlights coverage placement, typical site-of-service expectations, and coding context across major commercial and federal payers.

Readers will find: concise clinical context for when CPT code 31766 is reported; comparative payer coverage framing; and what to expect in claims lines and hospital billing workflows for complex airway reconstruction. The publication also outlines common billing modifiers when available and identifies areas where input data are incomplete. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 31766thoracic surgeryairway reconstructioncarina reconstructiononcologic surgeryinpatient surgerysurgical codinghospital billing

Billing Code Overview

CPT code 31766 describes a surgical procedure in which the provider reconstructs the carina after removal of a tumor. This represents a thoracic surgical reconstruction of the central airway following oncologic resection.

Service type: Surgical airway reconstruction related to tumor resection
Typical site of service: Hospital operating room or inpatient thoracic surgery setting

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a primary tracheobronchial tumor involving the carina (for example, squamous cell carcinoma or adenoid cystic tumor) who presents with progressive dyspnea, cough, hemoptysis, or recurrent pneumonia. Diagnostic workup includes chest CT with contrast, bronchoscopic evaluation with biopsy, pulmonary function testing, and cardiothoracic surgical assessment. The multidisciplinary team (thoracic surgery, pulmonology, anesthesia) determines surgical resection with carinal reconstruction (CPT 31766) when the lesion can be excised with negative margins and airway continuity must be restored. The patient is taken to the operating room for general endotracheal anesthesia, often with double-lumen tube or specialized airway management; intraoperative bronchoscopy confirms tumor extent. The surgeon performs tumor resection involving the distal trachea and carina followed by reconstruction of the carinal anatomy to re-establish airway bifurcation and bronchial continuity. Postoperative care includes ICU-level monitoring, ventilatory support as needed, chest physiotherapy, pain management, and surveillance bronchoscopy to assess anastomotic healing. Typical sites of service are an inpatient tertiary care hospital or an academic medical center with thoracic surgical capabilities. Expected clinical workflow includes preoperative staging, operative resection and reconstruction, immediate postoperative ICU care, and scheduled outpatient follow-up with imaging and bronchoscopic surveillance.

Coding Specifications

Modifier	Description	When to Use
`22`

CPT 31750: Repair of Cervical Trachea for Open Airway Reconstruction

CPT-31780-TRACHEAL-RESECTION-PRIMARY-ANASTOMOSIS

CPT 31780: Tracheal Resection with Primary Anastomosis

CPT-31830-TRACHEOSTOMY-PERISTOMAL-SCAR-EXCISION

CPT 31830: Removal of Peristomal Tracheostomy Scar Tissue

CPT-31825-TRACHEOSTOMY-TRACHEOCUTANEOUS-FISTULA-CLOSURE-PLASTIC-REPAIR

CPT 31825: Tracheostomy or Tracheocutaneous Fistula Closure, Plastic Repair

CPT-31781-TRACHEAL-STENOSIS-RESECTION-AND-ANASTOMOSIS-CERVICOTHORACIC

CPT 31781: Tracheal Stenosis Resection and Anastomosis

CPT-31805-TRACHEAL-WOUND-REPAIR-INTRATHORACIC

CPT 31805: Tracheal Wound Repair, Intrathoracic

CPT-31800-CERVICAL-TRACHEA-WOUND-CLOSURE-SUTURING

CPT 31800: Cervical Trachea Wound Closure, Suturing

CPT-31786-THORACIC-TRACHEAL-TUMOR-EXCISION

CPT 31786: Excision of Thoracic Tracheal Tumor

CPT-31770-AIRWAY-REPAIR-WITH-GRAFT-OR-PATCH

CPT 31770: Repair of Airway with Graft or Patch

CPT-31785-CERVICAL-TRACHEAL-TUMOR-EXCISION

CPT 31785: Excision of Cervical Tracheal Tumor

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Taxonomy Code	Specialty	Notes
`3336S0002X`	Thoracic Surgery	Primary specialty performing carinal tumor resection and reconstruction.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.01`	Malignant neoplasm of upper lobe, right bronchus or lung	Central lung cancers near the carina that may require carinal resection and reconstruction.

| C34.02 | Malignant neoplasm of upper lobe, left bronchus or lung | Tumors approaching the carina on the left side that may involve carinal reconstruction.

| C37 | Malignant neoplasm of trachea | Tracheal tumors involving the carina often necessitate carinal reconstruction after resection.

| C38.2 | Malignant neoplasm of mediastinum | Mediastinal tumors that invade the carina or mainstem bronchi leading to reconstruction.

| J98.4 | Other disorders of lung, not elsewhere classified | Used for complex airway obstruction or stenosis requiring surgical reconstruction when a neoplasm code is not primary.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31625`	Bronchoscopy, rigid or flexible, with removal of foreign body, tumor, or other obstruction when performed intraoperatively	Performed pre-resection for airway assessment or intraoperatively to assist tumor removal prior to carinal reconstruction.

| 32551 | Tube thoracostomy, includes water seal (separate procedure) | Commonly placed perioperatively to manage pleural drainage following thoracic airway surgery.

| 32820 | Thoracotomy for lung biopsy, wedge resection, or biopsy of tumor | May be performed when concomitant lung resection or biopsy is required with carinal tumor management.

| 31628 | Bronchoscopy with transbronchial biopsy | Used in preoperative diagnosis or staging to obtain tissue samples complementary to resection planning.

| 00532 | Anesthesia for thoracotomy, including major airway surgery | Anesthesia services commonly billed for thoracic airway operative procedures such as carinal reconstruction.

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