Bronchoscopy coding and NCCI bundling: 31622 through 31654.
The bronchoscopy family runs nearly thirty codes deep — from a plain diagnostic look to EBUS-guided nodal sampling and endobronchial valve placement — and almost every one can legitimately share a session with another. The coding question is never "was more than one thing done," it's whether the pair has an NCCI relationship at all, and whether that relationship's modifier indicator leaves any room for a modifier to work. This guide walks the full 31622–31654 range code by code, with the bundling logic and add-on pairing rules that decide what gets paid.
Key takeaways
- 31622's "separate procedure" status is why it bundles into nearly the whole family. Not just 31623/31625 — the same indicator-0 logic applies against almost any more extensive code billed the same session.
- Six codes in the range are add-ons, each pairing with exactly one base code. 31627, 31632, 31633, 31637, 31649, and 31651 are billable only in addition to the specific primary procedure they extend.
- 31652 and 31653 are mutually exclusive by station count, not an edit you can override. Bill the one code matching the total stations sampled — never both, never per station.
- Conventional TBNA (31629) and EBUS-guided sampling (31652/31653) reach the same anatomy differently. Billing both for one lymph node in one session reads as a duplicate, regardless of technique.
The full code family, base through advanced
Bronchoscopy sits in the "separate procedure" tradition common to endoscopic surgery: a base diagnostic exam code, fully payable on its own, that folds into any more extensive procedure through the same scope the same session (NCCI Policy Manual, Chapter 5 — Respiratory, Cardiovascular, Hemic and Lymphatic Systems). Bronchial thermoplasty (31660/31661) sits just above this range with its own bundling logic and isn't covered here.
Diagnostic and tissue-sampling codes (31622–31633)
| Code | Service | Billing note |
|---|---|---|
31622 | Diagnostic bronchoscopy, ± cell washing (base code, "separate procedure") | Not payable alongside a more extensive code, same session |
31623 | With brushing or protected brushings | Column 1 to 31622; indicator 0 |
31624 | With bronchoalveolar lavage (BAL) | Distinct technique from the wash included in 31622 |
31625 | With endobronchial biopsy, single or multiple sites | Column 1 to 31622; indicator 0 |
31626 | With placement of fiducial marker(s), single or multiple | Often paired with 31627 for nodule targeting |
31627 | Add-on: computer-assisted, image-guided navigation | Once per session, not per lobe; excludes 76376/76377 |
31628 | With transbronchial lung biopsy, single lobe | Base code for 31632 |
31629 | With transbronchial needle aspiration (TBNA), trachea/bronchi | Base code for 31633; once regardless of passes |
31632 | Add-on: transbronchial lung biopsy, each additional lobe | Pairs only with 31628 |
31633 | Add-on: TBNA, each additional lobe | Pairs only with 31629 |
Airway and therapeutic codes (31630–31646)
| Code | Service | Billing note |
|---|---|---|
31630 | Tracheal/bronchial dilation or closed reduction of fracture | |
31631 | Tracheal stent placement (includes dilation as required) | Dilation for the stent isn't separately billable as 31630 |
31634 | Balloon occlusion, assessment of air leak, administration of an occlusive substance (e.g., fibrin glue) | Bronchopleural fistula management, not valve placement |
31635 | Removal of foreign body | Includes the diagnostic exam — not billable with 31622 |
31636 | Bronchial stent placement, initial bronchus | Base code for 31637 |
31637 | Add-on: bronchial stent placement, each additional bronchus | Pairs only with 31636 |
31638 | Revision of tracheal/bronchial stent placed at a prior session | Distinct scenario from initial placement, not a duplicate |
31640 | Excision of tumor | Method-defined split from 31641 |
31641 | Destruction of tumor or relief of stenosis, any method other than excision (e.g., laser, cryotherapy) | |
31643 | Placement of catheter(s) for intracavitary radioelement application (endobronchial brachytherapy) | Catheter placement only, not the radiotherapy delivery |
31645 | Therapeutic aspiration of tracheobronchial tree, initial (same hospital stay) | |
31646 | Therapeutic aspiration, subsequent, same hospital stay | Never report 31645 twice in one stay |
EBUS and bronchial valve codes (31647–31654)
| Code | Service | Billing note |
|---|---|---|
31647 | Balloon occlusion and bronchial valve placement, initial lobe | Base code for 31651 |
31648 | Bronchial valve removal, initial lobe | Base code for 31649 |
31649 | Add-on: bronchial valve removal, each additional lobe | Pairs only with 31648 |
31651 | Add-on: bronchial valve placement, each additional lobe | Pairs only with 31647 |
31652 | EBUS-guided sampling, 1–2 mediastinal/hilar lymph node stations | Mutually exclusive with 31653 |
31653 | EBUS-guided sampling, 3 or more stations | Never bill in addition to 31652, same session |
31654 | Add-on: EBUS for a peripheral, non-nodal lesion | Pairs with a base code performed the same session |
Why 31622 almost never survives a same-session claim
31622 carries the CPT "separate procedure" designation, which exists to prevent double-billing a diagnostic exam inherent to a more extensive procedure through the same scope. The confirmed relationship is 31622 as the column 2 code against 31623 and 31625 with a modifier indicator of 0 — no modifier reverses that (AAPC coding guidance; CPT's separate-procedure convention). The same logic is why 31622 is typically non-payable alongside 31628, 31629, 31634, 31635, 31640, 31641, and the EBUS/valve codes performed the same session.
⚠️ This build confirmed the 31622→31623/31625 indicator-0 relationship against secondary billing-industry sources; it could not re-open CMS's primary NCCI PTP Edits file or current-quarter MUE tables to confirm every pair's exact indicator, since CMS's direct-fetch pages returned access errors during this build. Confirm the specific pair's current indicator in the CMS NCCI PTP Edits Lookup Tool before building it into a scrubber or an appeal — values update quarterly.
Add-on codes: one base code each, no exceptions
Six codes in this range only exist in addition to a specific primary procedure. Pairing an add-on with the wrong base code is a rejection, not a bundling denial — it fails claim edits before it reaches adjudication logic.
- 131627 (navigation) pairs with the primary code(s) — once per session, not per lobe, never with 76376/76377.
- 231632 (additional-lobe biopsy) pairs only with 31628; 31633 (additional-lobe TBNA) pairs only with 31629 — one unit per lobe, not per pass.
- 331637 (additional bronchial stent) pairs only with 31636, one unit per additional bronchus stented.
- 431649 (additional-lobe valve removal) pairs only with 31648; 31651 (additional-lobe valve placement) pairs only with 31647.
Name the specific additional lobe or bronchus for every add-on unit billed — "multiple lobes sampled" without naming which ones is the gap that turns a clean claim into a records request, or a recoupment once the note can't support the unit count.
EBUS: station counting and where 59/XS actually has a chance
31652 versus 31653 isn't an NCCI edit in the usual sense — it's a mutually exclusive pair by code descriptor, split purely on how many mediastinal or hilar lymph node stations were sampled (one or two versus three or more). Report the single code matching the final station count once the procedure is complete; there's no scenario where both are correctly billed together, and no modifier changes that.
The more common confusion is conventional TBNA versus EBUS-guided sampling of the same target. 31629 reports a blind aspiration; 31652/31653 report EBUS-guided sampling, where real-time ultrasound localizes the needle. Billing both for the same lymph node the same session is a duplicate regardless of technique — the record has to show genuinely separate targets before 59 or XS has anything real to document. Where the pair's indicator is 1, not 0, XS (separate structure) is almost always more defensible than generic 59, since it states the anatomic basis directly on the claim.
Before appending 59 or XS to any pair in this family, check the indicator first, not last. If it's 0 — true of most 31622 combinations — no note reverses it, and the time is better spent confirming the claim used the single correct code than drafting an appeal that can't succeed.
Do and don't
- Confirm the current NCCI indicator for the exact pair before appending 59 or XS.
- Pair every add-on code to its one correct base code, naming the additional lobe or bronchus in the note.
- Choose 31652 or 31653 by the actual station count sampled, once the procedure is complete.
- Document lobe, segment, or station specificity whenever more than one bronchoscopic code is billed the same session.
- Don't bill 31622 alongside any more extensive code in the family, same session.
- Don't bill 31653 in addition to 31652, or bill either code per station.
- Don't submit 31629 and 31652/31653 for the same lymph node target, same session.
- Don't append 59/XS to a pair with a confirmed 0 indicator — a high append rate on unwinnable pairs is exactly what payers flag for audit.
Bronchoscopy claims denying or underpaying on bundling?
We'll audit a sample of your recent bronchoscopy and EBUS claims, confirm which NCCI pairs actually carry an override-eligible indicator, and show what's recoverable.
Frequently asked questions
Can modifier 59 or XS ever unbundle 31622 from a same-session biopsy code?
No, not for the 31622-to-31623/31625 pair. CMS's NCCI PTP edit for that pair carries a modifier indicator of 0, meaning no modifier reverses it, because 31622 is a CPT-designated "separate procedure" inherent to any more extensive bronchoscopic work the same session. The same logic extends to 31622 billed alongside 31628, 31629, 31634, 31635, 31640, 31641, or the EBUS and valve codes. Confirm the current-quarter indicator for the specific pair in the CMS NCCI PTP Edits Lookup Tool before writing an appeal, since an indicator-0 denial isn't appealable no matter how the note documents the diagnostic portion.
Can we bill both 31652 and 31653 if we sampled two stations and then found a third?
No. 31652 and 31653 are mutually exclusive by definition, not an edit you can override. 31652 covers one or two mediastinal or hilar lymph node stations sampled that session, and 31653 covers three or more. Report the single code matching the total stations actually sampled, not one code per station and not both together. If the count changes mid-procedure, code to the final total once the session is complete.
Does the navigation add-on code 31627 get billed once per lobe navigated, or once per session?
Once per session, not once per lobe. 31627 is an add-on code reported once in addition to the primary bronchoscopy code(s) performed, regardless of how many lobes or targets the navigation system guided the physician to, and it isn't separately reportable alongside 76376/76377 (3D image post-processing), since 3D reconstruction is already part of its value. The same once-per-session logic applies to 31626 (fiducial marker placement) when billed with navigation for the same nodule workup.
Verify before billing. CPT is a registered trademark of the American Medical Association; codes here are paraphrased, not reproduced from the CPT Professional edition. CPT, HCPCS and ICD-10 codes, coverage policy, and bundling edits change, including annual code-set updates. This page reflects standard industry practice and is provided for general education — it is not a substitute for your own compliance review, your current payer contracts, or the current-year code sets. Confirm requirements against your specific payer mix before submitting claims.