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The procedure described by CPT® Code 31638 involves the use of a bronchoscope, which can be either rigid or flexible, to perform a detailed examination and intervention within the trachea and bronchi. This procedure includes fluoroscopic guidance when necessary, allowing for enhanced visualization during the intervention. The bronchoscope is inserted through the patient's nose or mouth and navigated into the oropharynx, where an initial examination occurs. The vocal cords are then visualized, followed by the advancement of the bronchoscope into the trachea, which is also thoroughly examined. The bronchoscope is further advanced into each mainstem bronchus to identify any abnormalities that may be present. In cases where a rigid bronchoscope is utilized, a telescope or flexible bronchoscope may be introduced through the rigid bronchoscope to facilitate visualization of the distal segments of the mainstem bronchi. A critical aspect of this procedure is the revision of a previously placed tracheal or bronchial stent that may have been improperly positioned or has migrated from its original placement. The physician may retrieve the stent, reposition it, or replace it with a new stent as needed. If there is a need for dilation prior to the stent revision, a balloon catheter is employed to open the obstructed or narrowed area by inflating the balloon one or more times. Subsequently, a stent delivery catheter or other stent delivery device is advanced through the bronchoscope to the targeted site, where the tracheal or bronchial stent is placed within the obstructed or stenosed lumen to restore and maintain airway patency.
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The procedure described by CPT® Code 31638 is indicated for patients who have previously undergone stent placement in the trachea or bronchi and require revision due to issues such as improper positioning or migration of the stent. The following conditions may warrant this procedure:
The procedure begins with the insertion of a bronchoscope, which can be either rigid or flexible, through the patient's nose or mouth. The bronchoscope is carefully advanced into the oropharynx, where an initial examination is conducted. Following this, the vocal cords are visualized and assessed for any abnormalities. The bronchoscope is then advanced into the trachea, allowing for a thorough examination of the tracheal lumen. After evaluating the trachea, the bronchoscope is further advanced into each mainstem bronchus to inspect for any irregularities or obstructions that may be present.
After the completion of the procedure, patients may require monitoring for any immediate complications or adverse reactions. The expected recovery may vary based on the individual patient's condition and the complexity of the procedure performed. Patients should be observed for signs of respiratory distress or complications related to the stent placement. Follow-up care may include imaging studies to confirm the proper placement of the stent and to assess the airway for any further obstructions. Additional considerations may involve the management of any underlying conditions that necessitated the stent placement in the first place.
| Short Descr | BRONCHOSCOPY REVISE STENT | Medium Descr | BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS | Long Descr | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as required) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 42 - Other OR therapeutic procedures on respiratory system |
This is a primary code that can be used with these additional add-on codes.
| 31627 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s]) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| 2005-01-01 | Added | First appearance in code book in 2005. |
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