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The procedure described by CPT® Code 31643 involves the use of a bronchoscope, which can be either rigid or flexible, to perform a detailed examination of the airways. The bronchoscope is inserted through the patient's nose or mouth and advanced into the oropharynx, allowing for a thorough visual inspection of the area. Fluoroscopic guidance may be utilized during the procedure to enhance visualization and ensure accurate placement of instruments. The examination includes the vocal cords and extends into the trachea, where any abnormalities can be identified. The bronchoscope is further advanced into each mainstem bronchus, facilitating a comprehensive assessment of the bronchial passages. In cases where a rigid bronchoscope is employed, a telescope or flexible bronchoscope may be inserted through it to visualize the distal segments of the mainstem bronchi more effectively. Once the examination is complete, an afterloading catheter is advanced through the bronchoscope to the targeted tumor area. If additional catheters are necessary for the procedure, the process is repeated to ensure proper placement. The position of the catheters is confirmed using fluoroscopy, which provides real-time imaging to verify accuracy. Following this, the patient is transferred to a shielded room where a radioactive source is afterloaded into the catheters using a remote device. This step is critical as it involves the application of intracavitary radioelements, a process known as brachytherapy, which is performed by a radiation oncologist and is reported separately. This procedure is essential for delivering targeted radiation therapy directly to the tumor site, maximizing treatment efficacy while minimizing exposure to surrounding healthy tissues.
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The procedure associated with CPT® Code 31643 is indicated for various conditions that require direct visualization and treatment of airway abnormalities. The following are explicitly provided indications for performing 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. This initial step allows access to the oropharynx, where a thorough examination is conducted. The bronchoscope is then advanced to visualize the vocal cords, ensuring that any abnormalities in this area are noted. Following this, the bronchoscope is further advanced into the trachea, allowing for a detailed inspection of the tracheal walls and any potential lesions or obstructions. Next, the bronchoscope is maneuvered into each mainstem bronchus, providing a comprehensive view of the bronchial passages. If a rigid bronchoscope is utilized, a telescope or flexible bronchoscope may be inserted through it to enhance visualization of the distal segments of the mainstem bronchi. This step is crucial for identifying any abnormalities that may not be visible with a standard bronchoscope. Once the examination is complete, the clinician advances an afterloading catheter through the bronchoscope to the area of the tumor. If additional catheters are necessary for effective treatment, the procedure is repeated to ensure that all required areas are addressed. The position of the catheters is confirmed using fluoroscopy, which provides real-time imaging to verify that the catheters are correctly placed in the targeted areas. After confirming the catheter positions, the patient is then moved to a shielded room. In this controlled environment, a radioactive source is afterloaded into the catheters using a remote device. This step is essential for the intracavitary radioelement application, also known as brachytherapy, which is performed by a radiation oncologist. This procedure is reported separately and is critical for delivering targeted radiation therapy directly to the tumor site.
Post-procedure care following the bronchoscopy with intracavitary radioelement application involves monitoring the patient for any immediate complications related to the procedure. Patients may experience some discomfort in the throat or chest, which should be managed appropriately. It is essential to observe for any signs of respiratory distress or bleeding, as these may indicate complications that require prompt intervention. Patients are typically advised to rest and avoid strenuous activities for a specified period following the procedure. The healthcare team will provide instructions regarding any necessary follow-up appointments and further imaging studies to assess the effectiveness of the treatment. Additionally, patients may be scheduled for routine evaluations to monitor their recovery and response to the brachytherapy. Overall, the post-procedure phase is crucial for ensuring patient safety and optimizing treatment outcomes.
| Short Descr | DIAG BRONCHOSCOPE/CATHETER | Medium Descr | BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL | Long Descr | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of catheter(s) for intracavitary radioelement application | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple 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. | 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) | P8F - Endoscopy - bronchoscopy | 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]) | 31654 | Addon Code MPFS Status: Active Code APC N ASC N1 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]) |
| 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). | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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| 2010-01-01 | Changed | Code description changed. |
| 2008-01-01 | Changed | Code description changed. |
| 2002-01-01 | Changed | Code description changed. |
| 2001-01-01 | Changed | Code description changed. |
| 1999-01-01 | Added | First appearance in code book in 1999. |
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