How To Use CPT Code 31643

CPT 31643 describes a specific procedure used in endoscopy to examine the trachea and bronchi. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 31643?

CPT 31643 is a code used to describe a procedure performed during endoscopy to visualize the trachea and bronchi. It involves the use of a bronchoscope, which is a flexible or rigid tube, to examine the airways and identify any abnormalities. The provider may also use fluoroscopic guidance, which involves the injection of a dye and the use of X-ray imaging to guide the passage of the scope and catheter. This code specifically includes the placement of catheter(s) for intracavitary radioelement application, which is a separate reportable service.

2. Official Description

The official description of CPT code 31643 is: ‘Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of catheter(s) for intracavitary radioelement application.’

3. Procedure

1. During the procedure, the provider inserts a bronchoscope, either flexible or rigid, through the nose or mouth to visualize the trachea and bronchi.
2. The provider advances the scope down into the throat and then into the bronchus and lung cavity.
3. Using the eyepiece, the provider examines the airways for any abnormalities or lesions.
4. If necessary, the provider passes a catheter through the channel in the scope and places it in the lung cavity.
5. At a later time, a separate provider may use this catheter for the placement of a radioactive substance in the lung cavity for radiotherapy.
6. Fluoroscopic guidance may be used during the procedure to assist in the placement of the scope and catheter.
7. Once the procedure is complete, the provider removes the scope, leaving the catheter in place, and monitors the patient for vital signs.

4. Qualifying circumstances

CPT 31643 is typically performed on patients who require a visual examination of their trachea and bronchi. This procedure may be necessary to identify and evaluate abnormalities, such as tumors or lesions, in the airways. The use of fluoroscopic guidance and the placement of catheter(s) for intracavitary radioelement application are additional qualifying circumstances for this code.

5. When to use CPT code 31643

CPT code 31643 should be used when a provider performs a bronchoscopy procedure with the specific inclusion of fluoroscopic guidance and the placement of catheter(s) for intracavitary radioelement application. It is important to note that this code should not be reported if the procedure does not involve these specific elements.

6. Documentation requirements

To support a claim for CPT 31643, the provider must document the following information:

• Patient’s medical history and reason for the procedure
• Details of the bronchoscopy procedure, including the type of scope used (flexible or rigid)
• Documentation of fluoroscopic guidance, if applicable
• Description of any abnormalities or lesions identified during the procedure
• Documentation of the placement of catheter(s) for intracavitary radioelement application, if applicable
• Date and duration of the procedure
• Any complications or adverse events that occurred during or after the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 31643, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The use of fluoroscopic guidance and the placement of catheter(s) for intracavitary radioelement application should be documented and supported by medical necessity. It is also important to follow any additional guidelines or requirements set forth by the payer or coding guidelines.

8. Historical information

CPT 31643 was added to the Current Procedural Terminology system on January 1, 1999. There have been several code changes and updates since its addition, including modifications to the code description and the addition of notes regarding intracavitary radioelement application.

9. Examples

1. A pulmonologist performs a bronchoscopy with fluoroscopic guidance and places a catheter for intracavitary radioelement application in a patient with lung cancer.
2. A thoracic surgeon uses a flexible bronchoscope with fluoroscopic guidance to examine the airways and places a catheter for intracavitary radioelement application in a patient with a suspected tumor.
3. An interventional radiologist performs a rigid bronchoscopy with fluoroscopic guidance and places a catheter for intracavitary radioelement application in a patient with recurrent pneumonia.
4. A radiation oncologist performs a bronchoscopy with fluoroscopic guidance and places a catheter for intracavitary radioelement application in a patient undergoing radiotherapy for lung cancer.
5. A pulmonologist uses a flexible bronchoscope with fluoroscopic guidance to visualize the airways and places a catheter for intracavitary radioelement application in a patient with a history of asbestos exposure.
6. A thoracic surgeon performs a rigid bronchoscopy with fluoroscopic guidance and places a catheter for intracavitary radioelement application in a patient with a suspected foreign body in the airway.