Assign Respiratory Procedure Codes - Certified Professional Coder CPC

1. A pulmonologist performs a thoracentesis with ultrasound guidance to drain a pleural effusion. Which CPT® code is reported?
   Answer: 32555 CPT® 32555 describes thoracentesis (needle or catheter aspiration of the pleural space) performed with imaging guidance (ultrasound or fluoroscopy). Code 32554 describes the same aspiration procedure without imaging guidance — the presence of ultrasound guidance is the sole differentiator between these two codes. Code 32551 describes tube thoracostomy (chest tube insertion with connection to water-seal drainage), which is a more invasive, indwelling drainage procedure distinct from a simple aspiration. Code 32550 describes insertion of an indwelling tunneled pleural catheter with a cuff (such as a PleurX catheter), which is used for long-term management of recurrent effusions and requires a tunneled tract.
2. A pulmonologist performs a diagnostic flexible bronchoscopy with cell washing only. Which CPT® code is reported?
   Answer: 31622 CPT® 31622 describes a diagnostic bronchoscopy with cell washing (obtaining secretions by lavage of the airway) as the highest-level service performed. Code 31623 describes bronchoscopy with bronchial brushings — a more active sampling technique than cell washing, using a brush to collect cells from the airway epithelium. Code 31624 describes bronchoscopy with bronchoalveolar lavage (BAL), which instills and recovers fluid from a distal segment, yielding more cells than simple washing. Code 31625 describes bronchoscopy with biopsy(ies) of the bronchial wall. When reporting bronchoscopy, use the most comprehensive service performed; however, if only diagnostic cell washing is performed and no biopsy, brushing, or BAL is done, 31622 is correct.
3. A pulmonologist performs a flexible bronchoscopy with bronchial brushings to collect cellular specimens. Which CPT® code is reported?
   Answer: 31623 CPT® 31623 describes bronchoscopy with bronchial brushings — a technique in which a small brush is advanced through the bronchoscope and used to collect cells from the airway surface. Code 31622 describes a diagnostic bronchoscopy with cell washing only; brushings provide a more active, targeted cellular collection than washing. Code 31624 describes bronchoalveolar lavage (BAL), which instills fluid into a distal airway segment for recovery of distal lung cells and organisms. Code 31625 describes tissue biopsy(ies) from the bronchial wall. Each sampling technique — washing (31622), brushings (31623), BAL (31624), and biopsy (31625) — has its own distinct code, and all four can be performed in the same session with appropriate reporting.
4. A thoracic surgeon performs an open total pneumonectomy for central lung cancer. Which CPT® code is reported?
   Answer: 32440 CPT® 32440 describes removal of the entire lung (pneumonectomy) via an open thoracotomy approach. Code 32480 describes removal of a single lobe (lobectomy), which preserves the remaining lobes of the lung. Code 32482 describes removal of two lobes (bilobectomy). Code 32484 describes removal of a single segment (segmentectomy), the most limited anatomic lung resection. The hierarchy of open lung resection codes (32484 segmentectomy < 32480 lobectomy < 32482 bilobectomy < 32440 pneumonectomy) reflects increasing amounts of lung tissue removed. Only 32440 describes complete removal of the entire lung.
5. A thoracic surgeon performs a VATS therapeutic wedge resection of a solitary pulmonary nodule, initial resection, unilateral. Which CPT® code is reported?
   Answer: 32666 CPT® 32666 describes thoracoscopy (VATS), surgical, with therapeutic wedge resection of the lung, initial unilateral — the correct code when a VATS wedge (non-anatomic) resection is performed to excise a mass or nodule. Code 32480 describes open (not VATS) single-lobe lobectomy, which is anatomic and far more extensive than a wedge resection. Code 32663 describes VATS lobectomy (removal of an entire lobe), not a wedge resection. Code 32484 describes open segmentectomy (anatomic segment resection), which is also more extensive than a VATS wedge. The approach (VATS vs. open) and the anatomic extent of resection (wedge vs. segment vs. lobe) are the key axes.
6. A surgeon performs functional endoscopic sinus surgery with total (anterior and posterior) ethmoidectomy. Which CPT® code is reported?
   Answer: 31255 CPT® 31255 describes nasal/sinus endoscopy, surgical, with total ethmoidectomy (both anterior and posterior cells). Code 31254 describes partial (anterior only) ethmoidectomy — the anterior vs. total distinction is the key differentiator between 31254 and 31255. Code 31256 describes a maxillary antrostomy, which addresses the maxillary sinus ostium and is not an ethmoidectomy. Code 31267 describes maxillary antrostomy with tissue removal — also involving the maxillary sinus, not the ethmoid complex. When coding FESS procedures, it is essential to identify which sinuses are addressed (ethmoid, maxillary, frontal, sphenoid) and the extent of each procedure.
7. A surgeon performs endoscopic sinus surgery with maxillary antrostomy only, without removal of tissue from inside the sinus. Which CPT® code is reported?
   Answer: 31256 CPT® 31256 describes nasal/sinus endoscopy, surgical, with maxillary antrostomy — enlargement of the maxillary sinus ostium without removing tissue from within the sinus itself. Code 31267 describes maxillary antrostomy with removal of tissue from the maxillary sinus; since no tissue removal from inside the sinus was performed, 31267 is incorrect. Code 31254 describes partial (anterior) ethmoidectomy, which addresses the ethmoid sinuses, not the maxillary ostium. Code 31255 describes total ethmoidectomy. The distinction between 31256 and 31267 is one of the most frequently tested FESS coding decisions: enlarging the opening (31256) versus enlarging the opening and removing sinus contents (31267).
8. A surgeon performs functional endoscopic sinus surgery (FESS) with maxillary antrostomy and removes tissue and polyps from inside the maxillary sinus. Which CPT® code is reported?
   Answer: 31267 CPT® 31267 describes nasal/sinus endoscopy, surgical, with maxillary antrostomy and removal of tissue from the maxillary sinus — the correct code when the surgeon both enlarges the maxillary ostium and physically removes tissue (polyps, fungal debris, mucous membrane) from within the sinus cavity. Code 31256 describes maxillary antrostomy alone, without tissue removal from inside the sinus; 31256 vs. 31267 is a high-frequency distinction on coding exams. Code 31254 describes partial (anterior) ethmoidectomy, which addresses the ethmoid sinuses, not the maxillary sinus. Code 31255 describes total (anterior and posterior) ethmoidectomy. The key differentiator between 31256 and 31267 is whether tissue is physically removed from inside the maxillary sinus in addition to enlarging the opening.
9. A thoracic surgeon performs a VATS pneumonectomy, removing the entire left lung. Which CPT® code is reported?
   Answer: 32671 CPT® 32671 describes thoracoscopy (VATS), surgical, with removal of the entire lung (pneumonectomy). Code 32663 describes VATS lobectomy of a single lobe — not the entire lung. Code 32670 describes VATS bilobectomy (removal of two lobes), which is less extensive than a pneumonectomy. Code 32669 describes VATS segmentectomy (removal of a single segment), the most limited anatomic VATS resection. The same hierarchy that applies to open resection codes (segment < lobe < two lobes < entire lung) applies to the VATS codes: 32669 < 32663 < 32670 < 32671.
10. A surgeon performs a planned tracheostomy on a 52-year-old patient requiring long-term mechanical ventilation. Which CPT® code is reported?
    Answer: 31600 CPT® 31600 describes a planned (non-emergency) tracheostomy as a separate surgical procedure — the correct code for an elective tracheostomy in any patient aged 2 years or older. Code 31601 describes a planned tracheostomy specifically in a patient younger than 2 years; age distinguishes 31601 from 31600. Codes 31603 and 31605 describe emergency tracheostomy procedures via the transtracheal route and cricothyroid membrane, respectively; a planned procedure is never coded with an emergency code. The two primary axes in tracheostomy coding are urgency (planned vs. emergency) and patient age (under 2 vs. 2 and older).
11. A surgeon performs a nasal/sinus endoscopy with resection of a polyp (polypectomy) from the nasal cavity. Which CPT® code is reported?
    Answer: 31237 CPT® 31237 describes nasal/sinus endoscopy, surgical, with biopsy, polypectomy, or debridement — the appropriate code when any combination of tissue removal (polyp, crust, inflammatory tissue) is performed during the nasal or sinus endoscopic procedure. Code 31231 is a diagnostic-only nasal endoscopy; it should not be reported when a surgical procedure (polypectomy) is performed during the same session. Code 31240 describes surgical endoscopy with concha bullosa resection, which involves removing an air cell within the middle turbinate — a distinct anatomic structure from a nasal polyp. Code 31254 describes partial (anterior) ethmoidectomy, which involves removing ethmoid air cells, not simply resecting a polyp from the nasal cavity.
12. A surgeon places a chest tube (tube thoracostomy) and connects it to a water-seal drainage system for a traumatic pneumothorax. Which CPT® code is reported?
    Answer: 32551 CPT® 32551 describes tube thoracostomy with connection to water-seal drainage, open — the standard intercostal chest tube for pneumothorax or hemothorax. Code 32550 describes insertion of an indwelling tunneled pleural catheter with a cuff (e.g., PleurX catheter), which involves subcutaneous tunneling and is used for chronic malignant effusions, not acute pneumothorax. Code 32554 describes thoracentesis (needle or catheter aspiration) without imaging guidance, which is a single-pass aspiration procedure, not a tube placed with water-seal drainage. Code 32555 describes thoracentesis with imaging guidance. Tube thoracostomy (32551) involves placing and securing a drainage tube, while thoracentesis (32554/32555) involves a single aspiration pass without an indwelling tube.
13. A thoracic surgeon performs an open surgical removal of a single lung segment for a small peripheral carcinoid tumor. Which CPT® code is reported?
    Answer: 32484 CPT® 32484 describes open removal of a single lung segment (segmentectomy), which preserves more lung parenchyma than a lobectomy and is appropriate for small peripheral lesions. Code 32480 describes open removal of a single lobe (lobectomy), which is a larger resection than a segmentectomy. Code 32482 describes open removal of two lobes (bilobectomy), an even larger resection. Code 32440 describes total pneumonectomy, which removes the entire lung. Within open lung resection, the amount of lung removed — segment, single lobe, two lobes, or entire lung — determines the correct code.
14. A thoracic surgeon performs a thoracoscopic (VATS) lobectomy removing the right lower lobe. Which CPT® code is reported?
    Answer: 32663 CPT® 32663 describes thoracoscopy (VATS), surgical, with lobectomy of a single lobe — the correct code for minimally invasive single-lobe resection. Code 32480 describes open (thoracotomy) lobectomy of a single lobe; the approach (VATS vs. open) distinguishes 32480 from 32663. Code 32671 describes VATS pneumonectomy (removal of an entire lung), not a single-lobe resection. Code 32670 describes VATS bilobectomy (removal of two lobes). When coding thoracic resections, identifying whether the approach is VATS or open, and whether the resection is one lobe, two lobes, a segment, or the entire lung, is essential.
15. A thoracic surgeon performs a VATS procedure with chemical pleurodesis using talc slurry to treat recurrent malignant pleural effusion. Which CPT® code is reported?
    Answer: 32650 CPT® 32650 describes thoracoscopy (VATS), surgical, with pleurodesis — whether chemical (talc, doxycycline) or mechanical — the correct code for any thoracoscopic pleurodesis procedure. Code 32500 describes open partial pleural resection, not pleurodesis via VATS. Code 32656 describes VATS with parietal pleurectomy, which physically removes the parietal pleura and is a different, more extensive procedure than pleurodesis alone. Code 32551 describes tube thoracostomy (open chest tube insertion) with water-seal drainage, which provides drainage but is not a pleurodesis procedure. The specific therapeutic intent — pleurodesis (adhesion creation) vs. pleurectomy (pleural removal) vs. drainage (tube placement) — is critical for distinguishing thoracic procedure codes.
16. A pulmonologist performs a flexible bronchoscopy with endobronchial ultrasound (EBUS) guided transbronchial sampling of 2 mediastinal lymph node stations for lung cancer staging. Which CPT® code is reported?
    Answer: 31652 CPT® 31652 covers bronchoscopy with endobronchial ultrasound (EBUS) guided transbronchial sampling of 1 or 2 mediastinal and/or hilar lymph node stations or structures — the correct code when real-time ultrasound visualization directs the sampling needle into paratracheal, subcarinal, or hilar nodes at 1 or 2 discrete stations. Code 31653 describes the same EBUS-guided procedure when 3 or more lymph node stations are sampled; the number of stations distinguishes 31652 from 31653. Code 31629 describes transbronchial needle aspiration (TBNA) without EBUS guidance — a blind or fluoroscopically guided technique that lacks real-time ultrasound visualization. Code 31628 describes transbronchial lung biopsy (parenchymal), not mediastinal lymph node sampling. The use of real-time EBUS guidance and the number of lymph node stations sampled are the defining axes for 31652 and 31653.
17. A radiologist performs a CT-guided percutaneous core needle biopsy of a lung mass. Which CPT® code is reported?
    Answer: 32408 CPT® 32408 describes a core needle biopsy of the lung or mediastinum, percutaneous, including imaging guidance when performed — the correct code for CT-guided core biopsy because imaging guidance is bundled into the code rather than reported separately. Code 32405 describes percutaneous biopsy of the pleura with image guidance — the target is the pleura, not the lung parenchyma. Code 32400 describes percutaneous needle biopsy of the pleura without imaging guidance, also targeting the pleural surface rather than the lung. Code 32420 describes pneumonocentesis (aspiration of fluid or air from lung parenchyma), not a tissue core biopsy. The anatomic target (lung/mediastinum vs. pleura) and the procedure type (core biopsy vs. aspiration) distinguish these percutaneous thoracic codes.
18. A surgeon performs a nasal/sinus endoscopy with resection of a concha bullosa (an air cell within the middle turbinate). Which CPT® code is reported?
    Answer: 31240 CPT® 31240 describes nasal/sinus endoscopy, surgical, with concha bullosa resection — the specific code for endoscopic removal of the air cell within the middle turbinate (pneumatized middle turbinate). Code 31231 is a diagnostic endoscopy only and should not be reported when a surgical resection is performed during the same session. Code 31237 describes surgical endoscopy with biopsy, polypectomy, or debridement — excising a nasal polyp is a different procedure from concha bullosa resection. Code 31255 describes total (anterior and posterior) ethmoidectomy, which removes the ethmoid air cells from the sinus labyrinth and is not the same as resecting a pneumatized middle turbinate. When a distinct, named endoscopic procedure is performed, the specific code (31240 for concha bullosa) should be used rather than a broader code.
19. A pulmonologist inserts an indwelling tunneled pleural catheter with a cuff for long-term management of a malignant pleural effusion. Which CPT® code is reported?
    Answer: 32550 CPT® 32550 describes insertion of an indwelling tunneled pleural catheter with a cuff — the tunneled, valve-containing catheter (e.g., PleurX catheter) used for chronic outpatient drainage of recurrent malignant pleural effusions. Code 32551 describes open tube thoracostomy with connection to a water-seal drainage system, which is a non-tunneled, hospital-based drain for acute conditions. Code 32554 describes thoracentesis (needle aspiration) without imaging guidance — a single-pass aspiration, not an indwelling catheter. Code 32555 describes thoracentesis with imaging guidance — also a single-pass aspiration. The tunneled, cuffed nature of the catheter (32550) distinguishes it from a standard chest tube (32551) and from a thoracentesis (32554/32555).
20. A physician performs a diagnostic nasal endoscopy, unilateral. Which CPT® code is reported?
    Answer: 31231 CPT® 31231 describes a diagnostic nasal endoscopy, which may be performed unilaterally or bilaterally; it is the baseline code when no surgical intervention is performed. Code 31233 describes diagnostic nasal endoscopy with maxillary sinusoscopy through the natural ostium — an additional diagnostic component that elevates the code. Code 31237 describes surgical nasal/sinus endoscopy with biopsy, polypectomy, or debridement; the diagnostic-only procedure (31231) should not be coded when a surgical endoscopy code is reported for the same session. Code 31240 describes surgical endoscopy with concha bullosa resection, a therapeutic procedure. When the endoscopy is purely diagnostic, 31231 is the correct selection.

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