How To Use CPT Code 31654

CPT 31654 describes the use of bronchoscopy with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic interventions for peripheral lesions. 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 31654?

CPT 31654 is a code used to describe a specific procedure involving bronchoscopy with transendoscopic endobronchial ultrasound (EBUS). This procedure allows the provider to use ultrasound guidance to evaluate and treat peripheral lesions in the trachea and bronchi. It is an add-on procedure that is performed in conjunction with a primary bronchoscopy. The code includes the use of fluoroscopic guidance if performed.

2. Official Description

The official description of CPT code 31654 is: ‘Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s]).’

Notes: (Use 31654 in conjunction with 31622, 31623, 31624, 31625, 31626, 31628, 31629, 31640, 31643, 31645, 31646) (For EBUS to access mediastinal or hilar lymph node station[s] or adjacent structure[s], see 31652, 31653) (Report 31652, 31653, 31654 only once per session)

3. Procedure

1. With the patient prepared and anesthetized for the primary bronchoscopy, the provider introduces an ultrasound probe through the scope.
2. The provider advances the probe down to the airways to be examined and emits high-frequency sound waves.
3. A computer converts the sound waves into real-time images on a screen, allowing the provider to visualize the airways, lungs, vessels, and lymph nodes.
4. The provider uses the ultrasound guidance to examine and biopsy peripheral lesions in the respiratory tract.
5. Once the examination and biopsies or treatments are complete, the provider removes the probe, biopsy instruments, and scope.
6. The patient is monitored for vital signs following the procedure.

4. Qualifying circumstances

CPT 31654 is used when the provider performs bronchoscopy with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic interventions for peripheral lesions. This procedure is typically performed on patients with suspected or known peripheral lesions in the trachea and bronchi. It is important to note that this code should not be used for mediastinal or hilar lesions, as there are separate codes for those procedures (31652, 31653).

5. When to use CPT code 31654

CPT code 31654 should be used when the provider performs bronchoscopy with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic interventions for peripheral lesions. It is important to ensure that the procedure is performed in addition to a primary bronchoscopy and that fluoroscopic guidance, if performed, is included in the code.

6. Documentation requirements

To support a claim for CPT 31654, the provider must document the following information:

• Indication for the procedure and the presence of peripheral lesions
• Details of the primary bronchoscopy procedure
• Use of transendoscopic endobronchial ultrasound (EBUS) during the procedure
• Fluoroscopic guidance, if performed
• Specific peripheral lesions examined or treated
• Biopsy or treatment performed on the lesions
• Any complications or adverse events
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 31654, it is important to ensure that the procedure is performed in addition to a primary bronchoscopy. The code should be reported only once per session, along with the appropriate primary bronchoscopy code. Fluoroscopic guidance, if performed, should not be reported separately as it is included in CPT 31654. It is also important to note that CPT 31654 should not be reported for mediastinal or hilar lesions, as there are separate codes for those procedures (31652, 31653).

8. Historical information

CPT 31654 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 pulmonologist performs bronchoscopy with transendoscopic endobronchial ultrasound (EBUS) to evaluate and biopsy a peripheral lesion in the trachea of a patient with suspected lung cancer.
2. A thoracic surgeon uses bronchoscopy with transendoscopic endobronchial ultrasound (EBUS) to guide the placement of a stent in a patient with a peripheral lesion causing airway obstruction.
3. An interventional radiologist performs bronchoscopy with transendoscopic endobronchial ultrasound (EBUS) to biopsy a peripheral lesion in the bronchi of a patient with suspected tuberculosis.