How To Use CPT Code 31645

CPT 31645 describes a specific endoscopy procedure performed on the trachea and bronchi. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 31645?

CPT 31645 is a code used to describe a specific endoscopy procedure performed on the trachea and bronchi. This procedure involves the use of a rigid or flexible bronchoscope to visually examine the airways and perform therapeutic aspiration of the tracheobronchial tree. The provider may or may not use fluoroscopic guidance during the procedure.

2. Official Description

The official description of CPT code 31645 is: ‘Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial (eg, drainage of lung abscess).’ This code specifically refers to the initial aspiration of the tracheobronchial tree during a bronchoscopy procedure.

3. Procedure

1. During the procedure, the provider inserts a rigid or flexible bronchoscope through the nose or mouth of the patient.
2. The bronchoscope is advanced down into the throat and then into the airways of the lung.
3. Using the eyepiece, the provider visually examines the mucus lining or covering of the airways, looking for any abnormalities such as a lung abscess.
4. If an abnormal fluid collection is identified, the provider introduces a catheter or needle through the channel in the bronchoscope and performs therapeutic aspiration of the tracheobronchial tree, removing the fluid.
5. Fluoroscopic guidance may be used to assist in performing the procedure.
6. Once the procedure is complete, the instruments and bronchoscope are removed, and the patient’s vital signs are monitored.

4. Qualifying circumstances

CPT 31645 is used when the provider performs the initial therapeutic aspiration of the tracheobronchial tree during a bronchoscopy procedure. This procedure is typically performed on patients with lung abscesses or other fluid collections in the airways that require drainage. The use of a rigid or flexible bronchoscope, as well as the inclusion of fluoroscopic guidance, if performed, distinguishes this code from other bronchoscopy codes.

5. When to use CPT code 31645

CPT code 31645 should be used when the provider performs the initial therapeutic aspiration of the tracheobronchial tree during a bronchoscopy procedure. It is important to ensure that the procedure meets the specific criteria outlined in the code description, including the use of a rigid or flexible bronchoscope and the inclusion of fluoroscopic guidance, if performed.

6. Documentation requirements

To support a claim for CPT 31645, the provider must document the following information:

• Indication for the procedure, such as the presence of a lung abscess or other fluid collection in the airways
• Details of the procedure performed, including the use of a rigid or flexible bronchoscope and the inclusion of fluoroscopic guidance, if applicable
• Date and duration of the procedure
• Findings from the visual examination of the airways
• Details of the therapeutic aspiration, including the amount and nature of the fluid removed
• Any complications or adverse events that occurred during or after the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 31645, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The use of a rigid or flexible bronchoscope and the inclusion of fluoroscopic guidance, if performed, should be documented and supported by the medical record. It is also important to follow any additional guidelines or requirements set forth by the payer or coding guidelines.

8. Historical information

CPT 31645 has undergone several changes since its addition to the Current Procedural Terminology system. The most recent change occurred on January 1, 2018, when the code description was updated to include specific examples of therapeutic aspiration, such as drainage of a lung abscess. Prior to that, changes were made in 2010, 2008, 2002, and 2001. The code was initially added to the system on January 1, 1990.

9. Examples

1. A patient presents with a lung abscess, and the provider performs a bronchoscopy with therapeutic aspiration of the tracheobronchial tree to drain the abscess.
2. During a bronchoscopy procedure, the provider identifies an abnormal fluid collection in the airways and performs therapeutic aspiration to remove the fluid.
3. A patient with a suspected lung abscess undergoes a bronchoscopy, and the provider confirms the presence of the abscess and performs therapeutic aspiration to drain it.
4. As part of a diagnostic bronchoscopy, the provider identifies a fluid collection in the tracheobronchial tree and performs therapeutic aspiration to remove the fluid.
5. A patient with a history of recurrent lung abscesses undergoes a bronchoscopy, and the provider performs therapeutic aspiration to drain the abscesses.
6. During a bronchoscopy procedure, the provider identifies an abnormal fluid collection in the airways and performs therapeutic aspiration to remove the fluid, using fluoroscopic guidance.
7. A patient with a suspected lung abscess undergoes a bronchoscopy, and the provider confirms the presence of the abscess and performs therapeutic aspiration to drain it, using fluoroscopic guidance.