How To Use CPT Code 31652

CPT 31652 describes the procedure of bronchoscopy with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 31652?

CPT 31652 can be used to describe a specific type of bronchoscopy procedure that involves the use of endobronchial ultrasound (EBUS) to guide transtracheal and/or transbronchial sampling. This code is used when the provider inserts a bronchoscope into the patient’s lungs and uses ultrasound guidance to take samples from one or two lymph node groupings in the mediastinal or hilar regions.

2. Official Description

The official description of CPT code 31652 is: ‘Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures.’

3. Procedure

1. The provider inserts a bronchoscope into the patient’s lungs through the nose or mouth.
2. The provider advances the bronchoscope through the trachea to the bronchus.
3. The provider uses fluoroscopy, or live X-ray imaging, to guide the passage of the bronchoscope.
4. The provider inserts an ultrasound transducer through the bronchoscope to emit and record high-frequency sound waves.
5. The provider uses the ultrasound images to locate and sample one or two lymph node groupings in the mediastinal or hilar regions.
6. The provider may use a biopsy needle or suction device to obtain tissue or fluid samples from the lymph nodes.
7. The provider removes the bronchoscope, ultrasound probe, and sampling instruments.

4. Qualifying circumstances

CPT 31652 is performed on patients who require sampling of lymph nodes in the mediastinal or hilar regions. The procedure is typically used for diagnostic purposes in cases where there is suspicion of lung cancer or other conditions affecting the lymph nodes in these regions. The use of endobronchial ultrasound (EBUS) allows for more precise guidance during the sampling procedure.

5. When to use CPT code 31652

CPT code 31652 should be used when the provider performs a bronchoscopy procedure with endobronchial ultrasound (EBUS) guidance and takes samples from one or two lymph node groupings in the mediastinal or hilar regions. This code should not be used for procedures involving three or more lymph node groupings, as there is a separate code (CPT 31653) for that scenario.

6. Documentation requirements

To support a claim for CPT 31652, the provider must document the following information:

• Indication for the procedure and the need for lymph node sampling
• Details of the bronchoscopy procedure, including the use of endobronchial ultrasound (EBUS) guidance
• Specific lymph node groupings sampled
• Any complications or adverse events that occurred during the procedure
• Results of the lymph node sampling, including any findings or diagnoses
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 31652, ensure that the procedure meets the criteria outlined in the official description. Use the appropriate CPT code based on the specific lymph node groupings sampled (one or two). It is important to note that CPT 31652 should not be reported with CPT code 31653, which is used for procedures involving three or more lymph node groupings. Additionally, be aware of any specific payer guidelines or requirements for reporting this code.

8. Historical information

CPT 31652 was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates or changes to the code since its addition.

9. Examples

1. A pulmonologist performing a bronchoscopy with endobronchial ultrasound (EBUS) guidance and sampling lymph nodes in the mediastinal region for a patient with suspected lung cancer.
2. An oncologist performing a bronchoscopy with endobronchial ultrasound (EBUS) guidance and sampling lymph nodes in the hilar region for a patient with a known diagnosis of lymphoma.
3. A thoracic surgeon performing a bronchoscopy with endobronchial ultrasound (EBUS) guidance and sampling lymph nodes in the mediastinal region for a patient with a suspicious lung nodule.
4. An interventional pulmonologist performing a bronchoscopy with endobronchial ultrasound (EBUS) guidance and sampling lymph nodes in the hilar region for a patient with a history of lung cancer.
5. A respiratory therapist performing a bronchoscopy with endobronchial ultrasound (EBUS) guidance and sampling lymph nodes in the mediastinal region for a patient with unexplained mediastinal lymphadenopathy.
6. A pathologist performing a bronchoscopy with endobronchial ultrasound (EBUS) guidance and sampling lymph nodes in the hilar region for a patient with a known diagnosis of sarcoidosis.