There has been some confusion about appropriate coding using the new endobronchial ultrasound codes with some of the other bronchoscopy codes. Notably, when CPT code 31629 bronchoscopy with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus is appropriate to use with code 31652 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 and 31654 code 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. Both 31652 and 31653 include needle sampling as a part of the work and therefore, if the bronchoscopy involves only the sampling of the hilar/mediastinal node, it would be inappropriate to include 31629.
However, mediastinal sampling is often done in conjunction with evaluation of a more peripheral lesion. If a bronchoscopy is performed with needle aspiration biopsy(ies) of a peripheral lesion and subsequently an EBUS scope is used to sample mediastinal or hilar lymph node stations, one could utilize 31629 as well as either 31652 or 31653. If EBUS is used to localize the peripheral node, the 31654 can also be used.
As an illustrative example, a 75 year old male is found to have a 2 cm peripheral nodule in the anterior segment of the right upper lobe with enlarged right hilar and subcarinal lymph nodes on CT scan. Bronchoscopy is performed and initially the patient has a survey bronchoscopy along with brushings and washing of the airway using a non-EBUS scope. A radial ultrasound probe is used to help identify the peripheral lesion and multiple needle biopsies are performed as are brushings and washings. Subsequently, an EBUS scope is introduced and right hilar, right paratracheal and subcarinal needle aspiration biopsies are performed. The appropriate codes to utilize to describe the work done in this procedure include 31623, 31629, 31653 and 31654. Had no peripheral needle biopsies been performed then code 31629 and 31654 would NOT be used.
