CPT code 31628 – Bronchoscopy with transbronchial lung biopsy

Key Takeaways

CPT code 31628 covers flexible or rigid bronchoscopy with transbronchial lung biopsy of a single lobe; 31629 is the add-on for each additional lobe biopsied in the same session.

Fluoroscopic guidance is included in the code descriptor when performed and cannot be billed separately under a standalone fluoroscopy code.

Documentation must explicitly identify the specific lobe biopsied, specimen count, and whether fluoroscopy was used; missing any of these triggers claim denial.

Pabau’s claims management software helps pulmonology and respiratory practices track claim status, manage NCCI-related denials, and submit clean claims through Claim.MD.

CPT code 31628: official descriptor and procedure overview

CPT code 31628 is defined by the American Medical Association as: Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe. It sits within the endoscopy subsection of the respiratory system surgery codes (31622-31654), all of which share the same base bronchoscopy service.

The CPT coding structure for bronchoscopy codes is hierarchical, and every code in the family includes the basic bronchoscopic insertion, advancement, inspection, and withdrawal as bundled components.

The key clinical components this code captures are:

1. Flexible or rigid bronchoscope insertion and navigation to the target lobe
2. Transbronchial forceps biopsy of tissue within that lobe
3. Fluoroscopic guidance when used for lesion localization

“Single lobe” is the primary billing limitation. If biopsy samples come from more than one pulmonary lobe, add-on code 31629 must be appended for each additional lobe beyond the first.

CPT code 31628 vs 31629: single lobe vs multiple lobes

The distinction between 31628 and 31629 is purely anatomical: which lobes were biopsied during the same bronchoscopic session. CPT code 31628 is the primary (base) code reported when biopsy is taken from one lobe. CPT 31629 is an add-on code reported for each additional lobe biopsied beyond the first.

If a pulmonologist biopsies the right upper lobe and the left lower lobe in one session, the correct billing is 31628 + 31629. Biopsying three lobes means 31628 + 31629 x2 (reported twice). Never report 31629 without 31628; it cannot be billed as a standalone code. Never report two units of 31628 for a two-lobe biopsy.

Adjacent bronchoscopy codes: how CPT code 31628 relates to 31622, 31624, and 31652

Understanding where 31628 sits within the broader bronchoscopy code family prevents unbundling errors and helps determine when additional codes can be legitimately reported in the same session. These procedure code families follow a consistent add-on and bundling logic across the CPT respiratory endoscopy section.

The most common error is billing 31622 alongside 31628 without justification. Per NCCI edit policy, 31622 (diagnostic bronchoscopy) is considered a component of any bronchoscopy that includes a diagnostic or therapeutic service.

When the bronchoscopy is performed purely to access the biopsy site, 31622 is bundled into 31628 and cannot be separately reported without modifier 59 and clear documentation showing a clinically distinct separate service at a separate site in the same session.

Modifiers for CPT code 31628

Modifier selection for CPT code 31628 affects claim acceptance, payment calculation, and audit risk. Using claims management software with built-in modifier logic reduces the risk of rejected or downcoded bronchoscopy claims. Below are the modifiers most commonly applied with this code.

• Modifier 59 (Distinct Procedural Service): Used when 31622 is legitimately billed alongside 31628 to indicate the diagnostic bronchoscopy represented a separate, distinct service not typically reported together. Requires clear operative note documentation. Overuse of modifier 59 is a known audit trigger.
• Modifier LT/RT (Left/Right): Some payers require anatomical laterality modifiers for bronchoscopy procedures. LT (left side) or RT (right side) may be appended when the biopsy is performed on a single lung. Not universally required; verify by payer policy.
• Modifier 22 (Increased Procedural Services): Appropriate when the procedure required substantially more time or complexity than typically required. Must be accompanied by a detailed operative note and often requires a separate cover letter explaining the additional work. Increases claim scrutiny.
• Modifier 51 (Multiple Procedures): Applicable when 31628 is performed alongside other surgical procedures in the same session that are not designated as add-on codes. Not appended to add-on code 31629.
• Modifier 76 (Repeat Procedure by Same Physician): Used when the same physician repeats 31628 on a different date of service. Not used for same-session repeat.
• Modifier 77 (Repeat Procedure by Another Physician): Used when a different physician repeats the procedure on a different date.

Documentation requirements for CPT code 31628

Inadequate operative notes are the leading cause of CPT code 31628 claim denials. The operative report must contain all of these elements to survive an audit or retrospective review. Practices using standardized clinical documentation requirements templates report fewer documentation-related denials across procedure codes.

Meeting the clean claim submission standard for 31628 means the operative report must affirmatively state the following before the claim goes out:

• Indication: Medical reason for the bronchoscopy and biopsy (e.g., unresolved lung mass, suspected malignancy, interstitial lung disease).
• Lobe(s) biopsied: The specific anatomical lobe must be named (right upper lobe, left lower lobe, etc.). “Lung biopsy performed” without lobe identification does not support the single-lobe designation.
• Specimen count: Number of specimens obtained from the lobe. Multiple specimens from the same lobe still constitute a single-lobe procedure.
• Fluoroscopy use: Explicit statement of whether fluoroscopic guidance was used. If used: note that it was employed for lesion localization and that imaging was performed. If not used: no separate code may be billed for guidance.
• Procedure findings: Gross description of the bronchoscopic view, any abnormalities visualized, and assessment of the biopsied site.
• Specimen disposition: Confirmation that specimens were sent to pathology with accession notation.
• Physician attestation: Signed attestation by the performing physician, confirming the single-lobe designation and the services provided.

ICD-10 diagnosis codes commonly paired with CPT code 31628

Medical necessity for CPT code 31628 is established through an appropriate ICD-10-CM diagnosis code. Payer LCD policies specify which diagnoses support coverage; pairing 31628 with a code outside the covered diagnoses list is a routine denial cause.

The superbill documentation should capture the primary diagnosis and any relevant secondary codes before the claim is submitted.

Medicare and payer coverage for CPT code 31628

Medicare covers CPT code 31628 when it meets Local Coverage Determination (LCD) medical necessity criteria established by the applicable Medicare Administrative Contractor (MAC). Understanding the coverage framework saves practices from submitting claims that will be denied on medical necessity grounds before the operative note is ever reviewed.

Solid medical billing workflows begin with payer-specific coverage verification before scheduling the procedure.

Coverage rules vary by MAC jurisdiction. Before performing elective bronchoscopy with transbronchial biopsy, verify the applicable LCD for your region. Common Medicare medical necessity requirements include:

• Documented imaging (chest CT or PET) showing a pulmonary lesion or abnormality requiring tissue diagnosis.
• Clinical history supporting pulmonary malignancy, interstitial lung disease, opportunistic infection, or other conditions where bronchoscopic biopsy is the appropriate diagnostic approach.
• Failure of or contraindication to less invasive diagnostic approaches when applicable.
• Physician documentation of the clinical decision to perform bronchoscopy rather than an alternative biopsy technique.

Commercial payers generally follow similar criteria but often add prior authorization requirements. Many major commercial insurers require pre-authorization for elective bronchoscopy with biopsy; this varies by plan and changes frequently.

Always verify directly with the specific plan before scheduling. Prior authorization requirements also apply in some Medicaid managed care plans.

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Pabau helps respiratory practices manage bronchoscopy claims, track NCCI edits, and submit clean claims through Claim.MD. See how Pabau handles the billing complexity so your team focuses on patient care.

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CPT code 31628 reimbursement: Medicare fee schedule rates

Medicare reimbursement for CPT code 31628 varies by practice setting and geographic locality. The CMS Medicare Physician Fee Schedule lookup tool is the authoritative source for current payment rates; the figures below reflect general national averages and should be verified against the current fee schedule year before billing. Submit claims electronically via electronic claims via Claim.MD to access real-time eligibility verification and track payment against the expected fee schedule amount.

Geographic payment localities adjust final reimbursement up or down. High-cost areas (e.g., Manhattan, San Francisco) pay above the national average; rural and lower-cost regions pay below. Use the FastRVU lookup tool to calculate locality-adjusted payments for your specific region. Verify current rates through the CMS MPFS lookup before publishing fee schedules or quoting expected reimbursement to patients.

Sound revenue cycle management practices treat fee schedule figures as estimates until the ERA confirms the actual payment.

Common reasons CPT code 31628 claims are denied

Claim denials for CPT code 31628 follow predictable patterns. Effective denial management strategies start by identifying the root cause rather than reflexively resubmitting. These are the denial triggers pulmonology billing teams encounter most often:

• Missing or insufficient operative note: The most common denial. A procedure note that says “bronchoscopy with biopsy performed” without specifying lobe, specimen count, or fluoroscopy use fails documentation review.
• Incorrect lobe designation: Billing 31628 when the operative note documents biopsies from two or more lobes without appending 31629. Auditors look specifically for this discrepancy.
• Bundling conflict with 31622: Billing diagnostic bronchoscopy (31622) and 31628 without modifier 59 when the two services were not clinically distinct. CMS NCCI edits bundle 31622 into higher-complexity bronchoscopy services.
• Missing prior authorization: Commercial payers that require pre-auth for elective bronchoscopy with biopsy will deny the claim if authorization was not obtained before the procedure date.
• ICD-10 mismatch (no medical necessity): Pairing 31628 with a diagnosis code outside the payer’s covered indication list. Common offenders include vague symptom codes when a more specific diagnosis is available and expected.
• Duplicate billing: Reporting two units of 31628 for a two-lobe biopsy instead of 31628 + 31629. Payers flag duplicate same-date-of-service same-code billing automatically.
• Fluoroscopy billed separately: Submitting a standalone fluoroscopy code alongside 31628 when fluoroscopic guidance is already bundled into the code descriptor.

Bundling rules and NCCI edits for CPT code 31628

The CMS National Correct Coding Initiative (NCCI) governs which codes can be billed together and under what circumstances. For CPT code 31628, the NCCI edit table establishes several column 1/column 2 pairs that pulmonology billing teams must know. Understanding medical billing compliance at the NCCI level prevents bundling errors before they become denials. Clearinghouse claim processing through Claim.MD includes built-in edit checks that flag NCCI conflicts before a claim reaches the payer.

NCCI edits are updated quarterly by CMS. The rules below reflect established policy, but always verify current edit status against the live NCCI table or use a tool like CrossCoder to check current modifier indicators before billing combinations.

OPPS packaging rules add another layer of complexity for hospital outpatient settings. Under OPPS, certain ancillary services (moderate sedation, pathology specimen handling) may be packaged into the primary procedure’s APC payment and cannot be separately billed by the facility. The physician’s professional fee is still billed separately under the MPFS. Practices billing in both the facility and professional components of the same bronchoscopy session should confirm which services are packaged at the OPPS level to avoid duplicate billing on the facility side.

Conclusion

CPT code 31628 is a clinically important but documentation-intensive procedure code. The single-lobe designation, the fluoroscopy bundling rule, and the NCCI edit relationship with 31622 are the three points where most billing errors originate. Clear operative notes that name the specific lobe biopsied and document fluoroscopy use are the foundation of a defensible claim.

Pabau’s claims management software helps pulmonology and respiratory practices submit clean bronchoscopy claims, track payment against the Medicare fee schedule, and manage NCCI-related denials through the Claim.MD clearinghouse integration.

To see how Pabau handles the billing workflow for procedure-intensive specialties, book a demo.

Continue your research

Need to understand how clearinghouse edits catch NCCI conflicts before submission? How Claim.MD clearinghouse processing works explains the pre-submission edit checks that flag bundling errors automatically.

Want a step-by-step guide to building cleaner claim submissions? Clean claim submission best practices covers the documentation and coding standards that prevent first-pass denials.

Looking to understand how denial patterns affect revenue cycle performance? What is revenue cycle management covers how bronchoscopy denials fit into the broader billing lifecycle.

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