How To Use CPT Code 31653

CPT 31653 describes a specific endoscopy procedure performed on the trachea and bronchi, which involves the use of a bronchoscope and ultrasound guidance to take samples from three or more lymph node stations or structures. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 31653?

CPT 31653 is a code used to describe a specific endoscopy procedure performed on the trachea and bronchi. This procedure involves the insertion of a bronchoscope, a thin flexible or rigid tube with a small video camera, into the patient’s lungs. The provider may use fluoroscopy, or live X-ray imaging, to guide the passage of the scope. The provider then uses ultrasound guidance in the throat and/or major air passages to the lungs to take samples from three or more lymph node stations or structures.

2. Official Description

The official description of CPT code 31653 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]), 3 or more mediastinal and/or hilar lymph node stations or structures.’

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate anesthesia and preparation of the bronchoscope.
2. The provider inserts the bronchoscope through the patient’s nose or mouth and advances it down into the throat, trachea, and bronchus.
3. The provider uses fluoroscopy, if necessary, to guide the passage of the bronchoscope.
4. The provider inserts an ultrasound transducer through the bronchoscope, which emits and records high-frequency sound waves to create real-time images of the airways, lungs, vessels, and lymph nodes.
5. The provider takes samples from three or more lymph node stations or structures using biopsy needles or suction devices passed through the bronchoscope.
6. The provider removes the ultrasound probe, sampling instruments, and bronchoscope.

4. Qualifying circumstances

CPT 31653 is used for patients who require endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling from three or more mediastinal and/or hilar lymph node stations or structures. This procedure is typically performed to obtain tissue samples for analysis in cases where there is suspicion of lung cancer or other conditions affecting the lymph nodes in the chest.

5. When to use CPT code 31653

CPT code 31653 should be used when the provider performs endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling from three or more mediastinal and/or hilar lymph node stations or structures. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 31653, the provider must document the following information:

• Indication for the procedure and the need for endobronchial ultrasound (EBUS) guided sampling
• Details of the procedure, including the use of fluoroscopic guidance and the number of lymph node stations or structures sampled
• Date and duration of the procedure
• Specific lymph node stations or structures sampled
• Any complications or adverse events that occurred during or after the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 31653, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the details of the procedure and any associated services provided. Additionally, be aware of any specific payer guidelines or requirements for reporting this code.

8. Historical information

CPT 31653 was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates to the code since its addition.

9. Examples

1. A provider performs endobronchial ultrasound (EBUS) guided transtracheal and transbronchial sampling from three mediastinal lymph node stations for a patient with suspected lung cancer.
2. During the procedure, the provider obtains samples from four hilar lymph node structures using endobronchial ultrasound (EBUS) guidance.
3. A patient with a history of lymphoma undergoes endobronchial ultrasound (EBUS) guided transtracheal and transbronchial sampling from five mediastinal lymph node stations for staging purposes.