CPT 31625: Complete Guide to Bronchoscopy With Biopsy Billing and Coding
Bronchoscopy biopsy claims are easy to get wrong in both directions. Code too high and a payer questions the record. Code too low and the practice leaves payment unclaimed. CPT 31625 is the code for bronchoscopy with bronchial or endobronchial biopsy, and it sits in a family of similar codes that differ in small but billable ways: brushing, lavage, transbronchial lung biopsy, needle aspiration.
At MedCloudMD, our billing specialists look at how procedure notes, diagnosis coding, edits, and payer rules fit together. This guide walks through CPT 31625 billing and coding the same way for 2026.
What Is CPT 31625?
CPT 31625 describes a rigid or flexible bronchoscopy, including fluoroscopic guidance when performed, with a bronchial or endobronchial biopsy at a single site or multiple sites. In plain terms, the physician examined the airways and took tissue from the bronchial wall or an endobronchial lesion. Because the code already covers single or multiple sites, it is generally reported once per session, however many samples were taken.
Pulmonologists, interventional pulmonology teams, thoracic surgeons, and the coders and billers who support them all need to know this code. The record must show a biopsy was actually obtained. An airway inspection alone, or one with only brushings or lavage, points to a different code.
Quick Code Snapshot
CPT Code | 31625 |
Procedure | Bronchoscopy with bronchial or endobronchial biopsy(s), single or multiple sites |
Primary Billing Focus | Matching the code to the biopsy actually obtained |
Documentation Priority | Biopsy site(s), method, findings, and specimen handling |
Common Risk Area | Choosing the wrong code in the bronchoscopy family, or billing bundled services separately |
How CPT 31625 Compares With Related Bronchoscopy Codes
Descriptions are condensed. Confirm exact wording in the current AMA CPT code set.
When Should CPT 31625 Be Reported?
Not every bronchoscopy becomes a 31625. Run through this decision checklist before you choose it.
Does the documentation support it? | If Yes | If No |
✓ Was bronchoscopy performed? | Continue | No bronchoscopy code applies |
✓ Was a biopsy actually obtained? | 31625 may apply | Consider 31622 to 31624 or 31629, based on what was done |
✓ Does the note clearly describe the service? | Continue | Query the physician before coding |
✓ Does the diagnosis support medical necessity? | Continue | Review documentation and payer policy |
✓ Are additional procedures separately reportable? | Check NCCI and payer edits | Report 31625 alone |
✓ Does payer policy affect reporting? | Apply the policy | Confirm none applies |
Documentation Requirements for CPT 31625
Vague notes cause many procedure-claim problems. A line reading "bronchoscopy with biopsy" doesn't tell a payer what was done, where, or why.
☐ Indication for the procedure | ☐ Relevant diagnosis |
☐ Anatomical site(s) and laterality | ☐ Procedure performed, including guidance used |
☐ Biopsy method and number of samples | ☐ Findings |
☐ Specimen labeling and destination | ☐ Medical necessity statement |
☐ Physician signature and date | ☐ Supporting records, such as prior imaging |
Some payers ask for more, such as imaging or authorization. Check current policies from your payers and Medicare Administrative Contractor.
CPT 31625 and ICD-10-CM Diagnosis Coding
CPT says what was done. ICD-10-CM says why. The diagnosis you link must come from the documented clinical picture and support the biopsy under the payer's policy. These examples show how to think about it. They are not a menu to pick from.
Diagnosis / Clinical Scenario | Coding Consideration | Documentation Focus |
Lung nodule or abnormal imaging | A code such as R91.1 (solitary pulmonary nodule) may fit when no definitive diagnosis exists | Imaging findings and why endobronchial sampling was chosen |
Suspected or confirmed lung cancer | Category C34 needs documented confirmation and specificity; for suspected cases, outpatient rules call for coding signs and findings | Pathology status, site, and laterality |
Suspected sarcoidosis or interstitial disease | Code the confirmed condition (such as D86.0 or J84.-) or the documented findings | Indication, imaging, and why tissue was needed |
Hemoptysis with an airway lesion | R04.2 and the documented finding may apply; add a confirmed diagnosis only once established | Findings and lesion site |
Code to the specificity the record supports. If pathology results arrive before you bill, follow official ICD-10-CM guidance and payer rules on how to use them.
CPT 31625 Modifiers
Modifiers describe special circumstances. They are not a way to raise payment, and each one must be supported by the record and allowed by payer and NCCI rules.
Modifier | When It May Be Relevant | What the Billing Team Should Verify |
25 | A significant, separately identifiable E/M visit on the same day | Documentation shows evaluation beyond the usual pre-procedure work |
51 | Multiple procedures in one session | Many payers apply reductions themselves; check whether they want it reported |
59 or X{EPSU} | A distinct service, such as a separate site or session, where an NCCI edit bundles two codes | Records prove the services were truly distinct, and which modifier the payer prefers |
22 | Substantially greater work than typical | Notes document the added time and effort, and the payer accepts it |
53 | Procedure started, then discontinued for patient safety | Whether a biopsy was obtained and how the payer handles discontinued services |
Common CPT 31625 Billing and Coding Mistakes
Use this Billing Mistake Detector as a pre-submission scan.
Problem | Why It Matters | How to Prevent It |
Reporting the wrong bronchoscopy code | The claim doesn't match the record, risking denial or overpayment | Code from the procedure note, not the order |
Coding from the diagnosis, not the procedure | Suspected cancer doesn't mean a biopsy happened | Confirm what was performed first |
Missing documentation | Absent sites, method, or specimen details invite records requests | Use a standard procedure note template |
Unsupported modifiers | Raises audit exposure and denials | Apply only with documentation and payer allowance |
Ignoring payer requirements | Indications and authorization rules differ | Keep a current payer policy reference |
Incorrect diagnosis linkage | Medical necessity denials | Link the diagnosis that supports the biopsy |
Billing bundled services separately | Edits reject or recoup payment, as with 31622 or included fluoroscopic guidance | Review NCCI edits before submission |
Skipping edit review and necessity checks | Preventable denials reach the payer | Scrub claims and confirm necessity first |
CPT 31625 Denial Prevention Checklist
☐ Procedure documentation reviewed | ☐ Biopsy clearly documented |
☐ Diagnosis supports medical necessity | ☐ CPT code matches the actual service |
☐ Modifiers verified | ☐ Payer requirements checked |
☐ NCCI/edit considerations reviewed | ☐ Documentation supports the claim |
☐ Claim information is consistent |
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Need help finding billing problems before they become denials? Talk with MedCloudMD's billing specialists. |
CPT 31625 Reimbursement: What Practices Should Know
There is no single payment for CPT 31625, and we don't publish an amount because it would be wrong for most readers. Payment varies by payer, geographic location, Medicare versus commercial coverage, contract terms, place of service, modifiers, multiple-procedure circumstances, documentation, and payer-specific policies.
To check current allowed amounts, use the CMS Physician Fee Schedule for Medicare in your locality, and your payer's fee schedule or contract for commercial plans. Also look at the global period and multiple-procedure rules that apply.
Quick reference: CPT 31625 is bronchoscopy with bronchial or endobronchial biopsy, generally reported once per session. It is not for brushing, lavage, transbronchial lung biopsy, or needle aspiration alone. Support it with documentation, then verify NCCI edits and payer policy. |
How Better Coding Supports the Revenue Cycle
Accurate coding is where the revenue cycle starts. A code that matches the record produces cleaner claims. Fewer denials mean less rework and less aging A/R, and notes that hold up under review support compliance. Results vary by payer and practice and none of this is guaranteed, but a consistent process makes revenue more predictable.
How MedCloudMD Can Help With Medical Billing
MedCloudMD is a medical billing and revenue cycle management company. We are a human-led billing team supported by technology and MedCloudMD AI: the technology helps flag issues, and our specialists make the judgment calls. Our team supports practices with medical billing, coding support, claims management, denial management, A/R follow-up, eligibility verification, credentialing, revenue cycle optimization, and specialty billing support for procedural services like bronchoscopy.
CPT 31625 FAQs
What is CPT 31625?
Bronchoscopy with a bronchial or endobronchial biopsy, single or multiple sites, including fluoroscopic guidance when performed.
When is CPT 31625 used?
When the record shows a biopsy of the bronchial wall or an endobronchial lesion. If only brushings, washings, or lavage were done, other codes apply.
What documentation is needed for CPT 31625?
The indication, diagnosis, biopsy sites and method, findings, specimen handling, and a signed procedure note. Payers may add requirements.
What diagnosis codes can support bronchoscopy with biopsy?
It depends on the documented condition, such as abnormal imaging, a confirmed lung disease, or a symptom like hemoptysis. No code guarantees medical necessity, so check payer policy.
Can modifiers be used with CPT 31625?
Yes, when documented and allowed, such as 25, 59 or X modifiers, or 22. They should never be used to get around an edit without support.
What are common CPT 31625 billing mistakes?
Choosing the wrong bronchoscopy code, thin documentation, unsupported modifiers, and reporting bundled services separately.
How can practices reduce bronchoscopy billing denials?
Code from the procedure note, verify necessity and payer rules, review NCCI edits, and track denial patterns by payer.
Disclaimer
This article is for general educational and informational purposes and is not medical, legal, coding, reimbursement, or compliance advice for any specific claim or patient. CPT, HCPCS, ICD-10-CM, payer policies, reimbursement rules, NCCI edits, and documentation requirements may change. Verify current official guidance and payer-specific requirements before submitting claims. MedCloudMD does not guarantee reimbursement or claim approval.
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