20 Jul 2017

Respiratory System Surgery Guidelines

Respiratory System

General Guidelines:
BIOPSY – Is part of excision / destruction / other type of removal of lesion either endoscopically or surgically at the same session, Hence biopsy should not be reported separately.

Even in multiple identical/similar lesions/at different area - the biopsy code is not separately reported. 

Eg: Patient with multiple nasal polyps, nasal obstruction & sinus obstruction

Procedure: Polypectomy and ethmoidectomy, Endoscopy

In this case CPT 31237 (Nasal endoscopy/surgical/ with biopsy, Polypectomy) should not be reported along with CPT 31255 (Nasal endoscopy/surgical, with ethmoidectomy) Biopsy is part of the procedure.


Diagnostic endoscopy of the respiratory system includes the access region and a separate code should not be used for this routine evaluation.

Eg 1: Anterior ethmoidectomy is endoscopically performed

In this case it is routine to evaluate the access region hence diagnostic nasal endoscopy is part of the procedure and should not be billed separately. (CPT 31231 - 31235)

Eg 2: Fiber optic bronchoscopy 

In this case it is routine to evaluate the access region (nasal cavity, the pharynx and larynx) only the bronchoscopy code is reported. (Don’t code Nasal endoscopy & laryngoscopy it is included in bronchoscopy)

When laryngoscopy is required to perform endotracheal tube placement – Code CPT 31500 (Intubation, endotracheal, emergency procedure)

Laryngoscopy is required to perform Tracheostomy (Code 31603 – 31614) – don’t code laryngoscopy.

CPT 31600 Tracheostomy placement (Include routine laryngotomy, laryngectomy, laryngoplasty codes)

Diagnostic endoscopy converted into open surgical procedure – Code only open procedure.

Open surgical procedure is accompanied by an endoscopy at the same session to evaluate the surgical field - surgical endoscopy is not separately reported.

Diagnostic endoscopy (sinus endoscopy, laryngoscopy, bronchoscopy, pleuroscopy etc) is included in surgical endoscopy performed at the same encounter.

Note: If diagnostic endoscopy is performed and decision is made to perform surgical endoscopy in post operative period then append modifier 58 as stage procedure

Eg: Patient with aspiration of foreign body

Bronchoscopy is performed indicating a foreign body obstruction attempt made to remove bronchoscopically – Code only 31635 (Surgical bronchoscopy with removal of foreign body) CPT 31622 (Bronchoscopy diagnostic) is included.

If it is unsuccessful and decided to perform thoracotomy (Planned) – Diagnostic bronchoscopy could be separately coded in addition to the thoracotomy. Modifier 58 may be used as staged procedure.

Surgical Sinus endoscopy includes a sinusotomy and diagnostic endoscopy         

Note: Bleeding control during a procedure is part of the endoscopy procedure it should not be billed separately. (CPT 30901 (Control of hemorrhage) is part of nasal endoscopy 31235 (endoscopy))

If bleeding is a late effect and required a procedure in post operative period would be billed with appropriate CPT and modifier 78 (related procedure)

When endoscopy procedures are performed – most comprehensive code describing the service rendered would be reported. If multiple procedures are performed and not adequate by single CPT – bill the services with appropriate CPT with modifier 51 (Multiple procedures) to the secondary services.