2025 CPT code 31625
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Respiratory System Surgery Feed
Bronchoscopy (rigid or flexible), with or without fluoroscopic guidance; with bronchial or endobronchial biopsy(s), single or multiple sites.
Modifiers may be necessary depending on the circumstances of the procedure (e.g., 22 for increased procedural service, 59 for distinct procedural service, 78 for unplanned return to the operating room). Consult the CPT manual for detailed modifier guidelines.
Medical necessity for a bronchoscopy with biopsy is established when there is a clinical indication suggesting the need for tissue sampling to diagnose or stage a lung condition, such as suspected lung cancer, unexplained respiratory symptoms, recurrent infections, or evaluation of interstitial lung disease.The procedure should be supported by appropriate clinical findings, imaging studies, and the physician's assessment of medical necessity.
The physician is responsible for performing the bronchoscopy, obtaining biopsies, interpreting the findings, and providing a diagnosis based on the pathology results.Pre-operative preparation, anesthesia administration, and post-operative care may involve other healthcare professionals.
In simple words: The doctor uses a thin, flexible tube with a camera (bronchoscope) to look inside your lungs' airways and take small tissue samples (biopsies) to check for lung problems.Sometimes, they use X-rays to guide the tube.
This CPT code encompasses bronchoscopy procedures using either rigid or flexible bronchoscopes.The procedure involves a visual examination of the airways, and the collection of one or more bronchial or endobronchial biopsies from single or multiple sites. Fluoroscopic guidance may be used, and is included in the code when performed. The biopsies are then sent for pathological analysis to aid in the diagnosis of lung diseases.
Example 1: A 65-year-old male presents with a persistent cough and hemoptysis. A chest CT scan reveals a suspicious nodule in the right lung. A bronchoscopy with transbronchial biopsy is performed to obtain tissue for cytological and histological analysis to rule out lung cancer., A 70-year-old female with a history of interstitial lung disease undergoes a bronchoscopy with biopsy to evaluate worsening respiratory symptoms. Multiple biopsies are taken from different lung segments to assess the extent and type of lung damage., A 50-year-old male smoker presents with recurrent pneumonia. Bronchoscopy with biopsy is performed to identify the cause of the recurrent infections.Bronchial washings are also obtained for microbiological testing.
* Detailed history and physical examination documenting the patient's symptoms and reasons for the procedure.* Imaging studies (chest X-ray, CT scan) showing the location of the abnormality.* Consent form signed by the patient or their legal guardian.* Procedure note detailing the technique used, number of biopsies, and the location(s) of the biopsy(ies).* Pathology report with the results of the biopsy analysis.* Anesthesia record.* Operative report.
** When reporting this code, ensure accurate documentation of the type of bronchoscope used, the number and location of biopsies taken, and the use of fluoroscopy.Specific details related to other procedures performed during the same session should be clearly documented and coded appropriately.
- Revenue Code: P8F (ENDOSCOPY - BRONCHOSCOPY)
- RVU: RVUs vary based on factors such as location (facility vs. non-facility), complexity of the procedure, and geographic practice cost index.Consult CMS guidelines and local payer policies for specific RVU values and reimbursement rates.
- Global Days: The global period for this procedure would depend on the specific details of the service rendered and local payer policy. The global period may be 0 days or more, depending on the nature of the biopsy and any associated procedures. Refer to payer guidelines for clarification.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier is not applicable to this code, as the code encompasses the entire procedure.
- Fee Schedule: Historical fee schedule data varies by payer and year. Consult historical fee schedules or databases to identify payments from prior periods.
- Specialties:Pulmonology, Thoracic Surgery, Oncology
- Place of Service:Office, Hospital (Inpatient/Outpatient), Ambulatory Surgery Center