What CPT (Current Procedural Terminology) code(s) are reported for a patient undergoing 5 transbronchial lung biopsies, with 1 biopsy in one lobe and 4 biopsies in another lobe?

CPT Coding for Transbronchial Lung Biopsies in Multiple Lobes

For a 20-year-old patient who underwent 5 transbronchial lung biopsies across 2 separate lobes (1 biopsy in one lobe and 4 biopsies in another lobe), the correct CPT code combination is 31628,31632.

Understanding Bronchoscopic Biopsy CPT Codes

The CPT coding for bronchoscopic procedures with transbronchial lung biopsies follows a specific structure:

• 31628: Base code for bronchoscopy with transbronchial lung biopsy(ies), single lobe
• 31632: Add-on code for each additional lobe biopsied (used with 31628)

Coding Logic for This Case

1. First lobe biopsy: Report 31628 for the bronchoscopy with transbronchial lung biopsy of the first lobe (regardless of whether 1 or multiple biopsies were taken from this lobe)

2. Second lobe biopsy: Report 31632 as an add-on code for the additional lobe that was biopsied (regardless of the number of biopsies taken from this second lobe)

Important Coding Principles

• The number of biopsies taken within each lobe does not affect the CPT code selection - what matters is the number of separate lobes biopsied
• The code 31628 covers all biopsies taken from a single lobe, whether it's one biopsy or multiple
• The add-on code 31632 is used once for each additional lobe biopsied beyond the first lobe
• The quantity of biopsies in each lobe (1 in one lobe, 4 in another) is not relevant to code selection

Clinical Considerations

While the guidelines don't specifically address CPT coding, they do provide context for transbronchial biopsy procedures:

• Transbronchial biopsies are important diagnostic tools for obtaining peripheral lung tissue for histopathological examination 1
• Multiple biopsies are often recommended to maximize diagnostic yield - guidelines suggest at least five endobronchial/transbronchial forceps biopsies should be obtained 1
• Biopsies from different lobes may be necessary as histologic patterns can be discordant between lobes 1

Common Coding Errors to Avoid

1. Reporting 31628 multiple times: The base code should only be reported once per procedure
2. Reporting 31632 multiple times for multiple biopsies in the same lobe: The add-on code is per additional lobe, not per additional biopsy
3. Confusing with 31629: This code is for EBUS-guided transbronchial needle aspiration, not standard transbronchial biopsies
4. Reporting 31632 × 4: This would incorrectly suggest biopsies of 4 additional lobes beyond the first

By correctly coding this procedure as 31628,31632, the provider appropriately captures the work of performing transbronchial biopsies in two separate lobes, regardless of the number of individual biopsies taken from each lobe.