HCPCS C7509: Image-Guided Diagnostic Bronchoscopy with Cell Washing

HCPCS Level II code C7509 represents an image-guided diagnostic bronchoscopy—rigid or flexible—performed with cell washings when indicated and using computer-assisted navigation, with fluoroscopic guidance when performed. This code captures advanced procedural technology applied to airway inspection and sampling, reflecting the increasing use of navigation and imaging adjuncts in pulmonary diagnostics. Nationally, such codes matter as they align coding with evolving procedural complexity and equipment use, affecting coding clarity and payer coverage determinations.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical intent and typical sites of service, guidance on common modifiers and billing considerations (listed separately), and an overview of what reviewers commonly assess for coverage: documentation of navigation use, fluoroscopy, and diagnostic cell washings. The publication also outlines related billing topics readers should review, including coding interactions with other bronchoscopic services and documentation best practices. Data not available in the input is noted where applicable.

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Billing Code Overview

HCPCS Level II code C7509 describes a diagnostic bronchoscopy, performed rigidly or flexibly, that includes cell washing(s) when performed and uses computer-assisted image-guided navigation, with fluoroscopic guidance when performed.

Service type: Image-guided diagnostic bronchoscopy with cell washing.

Typical site of service: Hospital outpatient department, ambulatory surgery center, or specialized pulmonary procedure suite, where advanced imaging and navigation systems and fluoroscopy are available.

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HCPCS C7509: Image-Guided Diagnostic Bronchoscopy with Cell Washing

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Billing Code Overview

Service type: Image-guided diagnostic bronchoscopy with cell washing.

Clinical & Coding Specifications

Clinical Context

A 63-year-old current smoker presents with persistent hemoptysis and a 3-cm peripheral pulmonary nodule on chest CT. Pulmonary medicine schedules a diagnostic bronchoscopy using computer-assisted image-guided navigation with fluoroscopic guidance to localize the lesion and obtain targeted bronchoscopic biopsies and bronchial washings for cytology. The patient arrives fasting to the ambulatory surgical center; pre-procedure assessment confirms informed consent, anticoagulation status, and topical anesthesia suitability. Under moderate sedation provided by an anesthesia professional, a flexible bronchoscope is introduced via the oral route. The navigation system registers CT landmarks to guide the bronchoscope to the peripheral target. Targeted brushings, forceps biopsies, and cell washings are obtained. Fluoroscopy is used intermittently to confirm instrument position. Specimens are sent to cytology and pathology. The patient recovers in the PACU, receives post-procedure instructions, and is discharged home the same day with follow-up arranged for pathology results.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R04.2`	Hemoptysis	Common indication prompting diagnostic bronchoscopy to locate bleeding source and obtain samples.
`R91.8`	Other nonspecific abnormal finding of lung field	Used for incidental or indeterminate pulmonary nodules requiring bronchoscopic evaluation.
`R91.1`	Solitary pulmonary nodule	Frequent indication for navigation bronchoscopy to obtain tissue from a peripheral nodule.
`J98.4`	Other disorders of lung, not elsewhere classified	Sometimes used for undifferentiated pulmonary symptoms requiring diagnostic bronchoscopy.
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Bronchoscopy with navigation is used to obtain biopsies for suspected lung cancer.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31622`	Bronchoscopy, rigid or flexible, with brushing or protected brushings	May be performed in the same session to obtain brushings when additional sampling is needed alongside navigation-guided biopsy.
`31623`	Bronchoscopy, with bronchial alveolar lavage (BAL) or washings	Represents collection of cell washings; often performed with navigation bronchoscopy and reported when BAL/washings are performed and billed separately per payer rules.
`31628`	Bronchoscopy, rigid or flexible, with transbronchial biopsy(s)	Used when transbronchial forceps biopsies of peripheral lung are obtained during navigation bronchoscopy.
`31645`	Bronchoscopy, with transbronchial lung biopsy; single lobe	Used when transbronchial lung biopsy is performed in a specific lobe as part of diagnostic workup; may be reported adjunctively per payer guidelines.
`32505`	Thoracentesis, needle drainage of pleural effusion (diagnostic)	May be performed before or after bronchoscopy if pleural fluid sampling is clinically indicated in the same episode of care.

Related Modifiers

9 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
66	Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…	- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
363LP0200X	Pediatric Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
224ZL0004X	Low Vision Occupational Therapy Assistant	Occupational therapy assistants contribute to the completion of an individualized occupational therapy low-vision evaluation under the direction and s…
1223D0001X	Public Health Dentistry	The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of…
261QI0500X	Infusion Therapy Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	Ambulatory Health Care Facilities · Clinic/Center

HCPCS Level II C1713: Implantable Anchor/Screw for Bone or Soft Tissue

HCPCS-C1714-TRANSLUMINAL-DIRECTIONAL-ATHERECTOMY-CATHETER

HCPCS C1714: Catheter, Transluminal Directional Atherectomy

HCPCS-C1715-BRACHYTHERAPY-NEEDLE

HCPCS C1715: Brachytherapy Needle

HCPCS-C1716-BRACHYTHERAPY-GOLD-198-SOURCE

HCPCS Level II C1716: Brachytherapy Source, Gold-198

HCPCS-C1717-HDR-BRACHYTHERAPY-IRIDIUM-192-SOURCE

HCPCS C1717: HDR Brachytherapy Iridium-192 Source

HCPCS-C1719-BRACHYTHERAPY-IRIDIUM-192-SOURCE-NON-STRANDED

HCPCS C1719: Brachytherapy Source, Iridium-192, Non-Stranded

HCPCS-C1721-IMPLANTABLE-DUAL-CHAMBER-CARDIOVERTER-DEFIBRILLATOR

HCPCS C1721: Implantable Dual-Chamber Cardioverter-Defibrillator

HCPCS-C1724-ROTATIONAL-TRANSLUMINAL-ATHERECTOMY-CATHETER

HCPCS C1724: Catheter for Transluminal Rotational Atherectomy

HCPCS-C1725-TRANSLUMINAL-ANGIOPLASTY-CATHETER-NON-LASER

HCPCS C1725: Transluminal Angioplasty Catheter, Non-Laser

HCPCS-C1726-NON-VASCULAR-BALLOON-DILATATION-CATHETER

HCPCS C1726: Catheter, Balloon Dilatation, Non-Vascular

Showing 1–10 of 603

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R04.2`	Hemoptysis	Common indication prompting diagnostic bronchoscopy to locate bleeding source and obtain samples.
`R91.8`	Other nonspecific abnormal finding of lung field	Used for incidental or indeterminate pulmonary nodules requiring bronchoscopic evaluation.
`R91.1`	Solitary pulmonary nodule	Frequent indication for navigation bronchoscopy to obtain tissue from a peripheral nodule.
`J98.4`	Other disorders of lung, not elsewhere classified	Sometimes used for undifferentiated pulmonary symptoms requiring diagnostic bronchoscopy.
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Bronchoscopy with navigation is used to obtain biopsies for suspected lung cancer.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31622`	Bronchoscopy, rigid or flexible, with brushing or protected brushings	May be performed in the same session to obtain brushings when additional sampling is needed alongside navigation-guided biopsy.
`31623`	Bronchoscopy, with bronchial alveolar lavage (BAL) or washings	Represents collection of cell washings; often performed with navigation bronchoscopy and reported when BAL/washings are performed and billed separately per payer rules.
`31628`	Bronchoscopy, rigid or flexible, with transbronchial biopsy(s)	Used when transbronchial forceps biopsies of peripheral lung are obtained during navigation bronchoscopy.
`31645`	Bronchoscopy, with transbronchial lung biopsy; single lobe	Used when transbronchial lung biopsy is performed in a specific lobe as part of diagnostic workup; may be reported adjunctively per payer guidelines.
`32505`	Thoracentesis, needle drainage of pleural effusion (diagnostic)	May be performed before or after bronchoscopy if pleural fluid sampling is clinically indicated in the same episode of care.

Related Modifiers

9 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
66	Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…	- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
363LP0200X	Pediatric Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
224ZL0004X	Low Vision Occupational Therapy Assistant	Occupational therapy assistants contribute to the completion of an individualized occupational therapy low-vision evaluation under the direction and s…
1223D0001X	Public Health Dentistry	The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of…
261QI0500X	Infusion Therapy Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	Ambulatory Health Care Facilities · Clinic/Center

HCPCS Level II C1713: Implantable Anchor/Screw for Bone or Soft Tissue

HCPCS-C1714-TRANSLUMINAL-DIRECTIONAL-ATHERECTOMY-CATHETER

HCPCS C1714: Catheter, Transluminal Directional Atherectomy

HCPCS-C1715-BRACHYTHERAPY-NEEDLE

HCPCS C1715: Brachytherapy Needle

HCPCS-C1716-BRACHYTHERAPY-GOLD-198-SOURCE

HCPCS Level II C1716: Brachytherapy Source, Gold-198

HCPCS-C1717-HDR-BRACHYTHERAPY-IRIDIUM-192-SOURCE

HCPCS C1717: HDR Brachytherapy Iridium-192 Source

HCPCS-C1719-BRACHYTHERAPY-IRIDIUM-192-SOURCE-NON-STRANDED

HCPCS C1719: Brachytherapy Source, Iridium-192, Non-Stranded

HCPCS-C1721-IMPLANTABLE-DUAL-CHAMBER-CARDIOVERTER-DEFIBRILLATOR

HCPCS C1721: Implantable Dual-Chamber Cardioverter-Defibrillator

HCPCS-C1724-ROTATIONAL-TRANSLUMINAL-ATHERECTOMY-CATHETER

HCPCS C1724: Catheter for Transluminal Rotational Atherectomy

HCPCS-C1725-TRANSLUMINAL-ANGIOPLASTY-CATHETER-NON-LASER

HCPCS C1725: Transluminal Angioplasty Catheter, Non-Laser

HCPCS-C1726-NON-VASCULAR-BALLOON-DILATATION-CATHETER

HCPCS C1726: Catheter, Balloon Dilatation, Non-Vascular

Showing 1–10 of 603

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS C7509: Image-Guided Diagnostic Bronchoscopy with Cell Washing

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Billing Code Overview

OpenPayer

HCPCS C7509: Image-Guided Diagnostic Bronchoscopy with Cell Washing

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

HCPCS C7509: Image-Guided Diagnostic Bronchoscopy with Cell Washing

Sign up for hcpcs C7509 policy alerts

Billing Code Overview

HCPCS C7509: Image-Guided Diagnostic Bronchoscopy with Cell Washing

Sign up for hcpcs C7509 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What procedure and technologies does HCPCS C7509 represent, and where is it typically performed?

What elements of documentation do reviewers commonly assess for claims billed with C7509?

Which related CPT codes might be reported alongside or in the same session as C7509?

Which modifiers are relevant to C7509 and when are they used?

Which specialties commonly perform procedures reported with C7509 and which payers are referenced in the analysis?

References

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What procedure and technologies does HCPCS C7509 represent, and where is it typically performed?

What elements of documentation do reviewers commonly assess for claims billed with C7509?

Which related CPT codes might be reported alongside or in the same session as C7509?

Which modifiers are relevant to C7509 and when are they used?

Which specialties commonly perform procedures reported with C7509 and which payers are referenced in the analysis?

References