🧬 CPT 31615 — Tracheobronchoscopy Through Established Tracheostomy Incision

Code Description

Official CPT Description: Tracheobronchoscopy through established tracheostomy incision

CPT 31615 reports a diagnostic and/or therapeutic endoscopic procedure in which a flexible bronchoscope is introduced through a pre-existing, previously created tracheostomy stoma — rather than through the mouth (transoral), nose (transnasal), or larynx — to directly visualize the trachea, carina, and bronchial tree. The procedure requires that the tracheostomy be established (i.e., mature or previously placed) at the time of the bronchoscopy. It does not apply to a scope passed through a freshly created tracheostomy in the same operative session, and it does not apply to standard oral or nasal bronchoscopy.

This is one of the most commonly performed bedside or OR procedures in patients who are on long-term mechanical ventilation, those with chronic airway conditions requiring repeated visualization, or any patient with a tracheostomy who develops an acute respiratory complication requiring direct airway assessment. The tracheostomy access route simplifies scope insertion, reduces patient discomfort compared to transoral approaches, and allows rapid access in emergent situations without the need to navigate the upper airway or vocal cords.

The code encompasses both the diagnostic visualization component (inspection of the tracheobronchial tree) and any incidental minor therapeutic work that is part of the same operative session, such as clearance of secretions encountered during the examination. However, when discrete therapeutic interventions such as biopsy, brushing, lavage, or dilation are performed, those additional procedures may be separately reported using appropriate add-on or companion codes (see Code Tree section below).

Anatomy & Clinical Context

The trachea is a cartilaginous and membranous tube approximately 10-12 cm in length in adults, extending from the inferior border of the cricoid cartilage (at approximately the C6 vertebral level) downward to the carina at the level of the sternal angle (T4/T5), where it bifurcates into the right and left main bronchi. The trachea consists of 16-20 C-shaped hyaline cartilage rings anterolaterally and a posterior membranous wall.

A tracheostomy creates an artificial opening (stoma) through the anterior neck skin and anterior tracheal wall, typically placed between the 2nd and 4th tracheal rings. This stoma, once epithelialized and mature (generally after 5-7 days), constitutes the “established tracheostomy incision” referenced in CPT 31615. A tracheostomy tube (cuffed or uncuffed, fenestrated or solid) is typically in place within the stoma, though the procedure can sometimes be performed with the tube temporarily removed and the scope inserted directly through the stoma.

Common clinical reasons for performing 31615 include:

Evaluation of airway obstruction in a ventilator-dependent patient
Assessment of mucus plugging, secretion retention, or lobar/segmental atelectasis
Investigation of hemoptysis in a tracheostomy-dependent patient
Surveillance bronchoscopy in patients with known tracheal stenosis, subglottic stenosis, or tracheomalacia
Assessment of tracheostomy tube position and tracheal wall integrity (granulation tissue, tracheal injury, tracheomalacia at the cuff site)
Diagnostic evaluation for suspected tracheobronchitis, pneumonia, or aspiration
Clearance of thick inspissated secretions, mucus casts, or obstructing crusts
Foreign body evaluation distal to the tracheostomy site
Preoperative assessment prior to tracheostomy decannulation
Postoperative airway surveillance after laryngotracheal reconstruction

Procedure Overview

The patient is positioned supine. Topical anesthesia may be administered into the tracheobronchial tree via the tracheostomy using aerosolized or instilled lidocaine. Sedation may be administered per operator preference and clinical situation.
The tracheostomy tube, if present, is removed or deflated to allow insertion of the bronchoscope. In some cases, the scope is passed through the lumen of a tracheostomy tube if the inner diameter is large enough.
The flexible bronchoscope (typically a standard 4-6 mm outer diameter pediatric or adult flexible scope) is inserted through the established tracheostomy stoma.
The scope is advanced distally. The tracheal lumen, tracheal wall mucosa, carina, right and left main bronchi, lobar and segmental bronchi are systematically inspected.
Any diagnostic or therapeutic interventions are performed as indicated — including suctioning, lavage, brushings, or biopsy. If these additional steps are performed, companion or add-on codes may apply.
Following complete inspection of both the right and left bronchial trees to the desired level, the scope is withdrawn.
The tracheostomy tube is repositioned and secured. Ventilator settings are restored and patient tolerance is assessed.

ICD-10-CM Diagnosis Codes

The following diagnosis codes represent the most clinically relevant indications supporting medical necessity for CPT 31615. This is a heterogeneous procedure in terms of indication — the underlying reason for a patient having a tracheostomy in the first place is usually the most important context for code selection.

Tracheostomy Complications (Most Specific for This Procedure)

J95.00 — Unspecified tracheostomy complication. Used when the documentation indicates a tracheostomy complication but does not further specify the nature.
J95.01 — Hemorrhage from tracheostomy stoma. Bronchoscopy is performed to identify the bleeding source and assess the stoma and distal trachea.
J95.02 — Infection of tracheostomy stoma. Scope may assess for distal extension of infection into the trachea.
J95.03 — Malfunction of tracheostomy stoma. Includes partial obstruction, granulation tissue obstruction, or tube displacement causing inadequate airway.
J95.09 — Other tracheostomy complication. Covers tracheomalacia at the cuff site, tracheoesophageal fistula, tracheal stenosis arising as a complication of the tracheostomy itself.

Airway / Respiratory Indications

J98.09 — Other diseases of bronchus, not elsewhere classified. Covers granulation tissue, bronchial polyp, inspissated secretions not otherwise specified.
J98.11 — Atelectasis. Bronchoscopy is performed to clear mucus plugging causing lobar or segmental collapse.
J69.0 — Pneumonitis due to inhalation of food and vomit (aspiration pneumonitis). Bronchoscopy to clear aspirated material.
J18.9 — Pneumonia, unspecified organism. Bronchoscopy to obtain diagnostic specimens (BAL, brushings) from a suspected pneumonia in a ventilated patient.
J22 — Unspecified acute lower respiratory infection.
J98.01 — Acute bronchospasm.
J44.1 — Chronic obstructive pulmonary disease with acute exacerbation.

Hemoptysis

R04.2 — Hemoptysis. Bronchoscopy through the tracheostomy to localize the source of bleeding within the tracheobronchial tree.

Tracheal Stenosis

J95.5 — Postprocedural subglottic stenosis. When tracheal stenosis develops as a complication of prior intubation or tracheostomy.
J39.8 — Other specified diseases of upper respiratory tract. May include tracheal stenosis not elsewhere classified.
Q32.1 — Congenital tracheal stenosis. Bronchoscopy in a pediatric patient with congenital airway narrowing.

Neoplasm Surveillance

C34.10 through C34.92 — Malignant neoplasm of bronchus and lung. Bronchoscopy for tumor surveillance, repeat biopsy, or post-treatment assessment.
D14.2 — Benign neoplasm of trachea. Assessment of known tracheal tumor.
D38.1 — Neoplasm of uncertain behavior of trachea, bronchus and lung.

Other Common Secondary Diagnoses

Z93.0 — Tracheostomy status. Always reported as a secondary diagnosis when the patient has an established tracheostomy, regardless of whether the tracheostomy itself is the reason for the encounter.
Z99.11 — Dependence on respirator (ventilator) status. Reported as a secondary diagnosis when the patient is ventilator-dependent.
J96.00 / J96.01 / J96.09 — Acute respiratory failure (with or without hypoxia/hypercapnia). May be the precipitating reason for the bronchoscopy in critically ill patients.

ICD-10-PCS Crosswalk (Inpatient Facility)

In the inpatient setting, CPT codes are not used — ICD-10-PCS procedure codes are assigned. For tracheobronchoscopy through an established tracheostomy, the applicable PCS root operation is Inspection (J), within the Respiratory System (B) body system under the Medical and Surgical (0) section.

The body part selected depends on the most distal anatomic structure visualized or treated. PCS Guideline B3.11a states that inspection of a body part(s) performed in order to achieve the objective of a procedure is not coded separately when it is included in another procedure already coded. However, when bronchoscopy is the sole or primary procedure, the Inspection root operation is appropriate.

The approach for a tracheostomy access bronchoscopy is Via Natural or Artificial Opening (7) or Via Natural or Artificial Opening Endoscopic (8), since the established stoma functions as a pre-existing artificial opening.

Pure Inspection / Diagnostic Bronchoscopy:

0BJ17ZZ — Inspection of Trachea, Via Natural or Artificial Opening
0BJ18ZZ — Inspection of Trachea, Via Natural or Artificial Opening Endoscopic
0BJ27ZZ — Inspection of Carina, Via Natural or Artificial Opening
0BJ28ZZ — Inspection of Carina, Via Natural or Artificial Opening Endoscopic
0BJ37ZZ — Inspection of Right Main Bronchus, Via Natural or Artificial Opening
0BJ38ZZ — Inspection of Right Main Bronchus, Via Natural or Artificial Opening Endoscopic
0BJ77ZZ — Inspection of Left Main Bronchus, Via Natural or Artificial Opening
0BJ78ZZ — Inspection of Left Main Bronchus, Via Natural or Artificial Opening Endoscopic

When Lavage/Drainage Is Performed:

0B917ZX — Drainage of Trachea, Via Natural or Artificial Opening, Diagnostic
0B937ZX — Drainage of Right Main Bronchus, Via Natural or Artificial Opening, Diagnostic
0B977ZX — Drainage of Left Main Bronchus, Via Natural or Artificial Opening, Diagnostic

When Excision / Biopsy Is Performed:

0BB17ZX — Excision of Trachea, Via Natural or Artificial Opening, Diagnostic
0BB37ZX — Excision of Right Main Bronchus, Via Natural or Artificial Opening, Diagnostic
0BB77ZX — Excision of Left Main Bronchus, Via Natural or Artificial Opening, Diagnostic

Coding Guidance: PCS coding logic differs significantly from CPT. Under PCS, if the physician both inspects and takes a biopsy, only the more definitive root operation (Excision) is reported — the Inspection is not coded separately per PCS Guideline B3.11a. The coder should select the body part code corresponding to the most distal or most significant structure operated upon, not a separate code for each level inspected. The approach character (7 vs 8) depends on whether the procedure is performed with (8 - endoscopic) or without (7 - direct manual) an optical instrument, though in practice the endoscopic approach (8) is almost universally the correct character for flexible bronchoscopy.

MS-DRG Assignment

CPT 31615 / ICD-10-PCS bronchoscopic procedures through a tracheostomy stoma fall within MDC 04 (Diseases and Disorders of the Respiratory System) when performed in the inpatient setting.

Important nuance for inpatient coders: Whether a bronchoscopy procedure is classified as an OR procedure (triggering a surgical DRG) versus a non-OR procedure (triggering a medical DRG) in the MS-DRG grouper depends on the specific ICD-10-PCS code assigned. Inspection-only codes (0BJ1xZZ, 0BJ2xZZ, 0BJ3xZZ, etc.) are generally classified as non-OR procedures in the MS-DRG v43.0 grouper, meaning they do not trigger a surgical DRG on their own. However, when excision (biopsy), drainage with device, or other OR-designated PCS codes are assigned, the stay will group to a surgical DRG.

Surgical DRGs (when PCS code is OR-designated):

MS-DRG 166 — Other Respiratory System O.R. Procedures with MCC
MS-DRG 167 — Other Respiratory System O.R. Procedures with CC
MS-DRG 168 — Other Respiratory System O.R. Procedures without CC/MCC

Major Chest Procedure DRGs (if combined with thoracic surgery):

MS-DRG 163 — Major Chest Procedures with MCC
MS-DRG 164 — Major Chest Procedures with CC
MS-DRG 165 — Major Chest Procedures without CC/MCC

Medical DRGs (when PCS Inspection code only is assigned — non-OR):

MS-DRG 189 — Pulmonary Edema and Respiratory Failure with MCC
MS-DRG 190 — Chronic Obstructive Pulmonary Disease with MCC
MS-DRG 193 — Simple Pneumonia and Pleurisy with MCC
MS-DRG 177 — Respiratory Infections and Inflammations with MCC
MS-DRG 178 — Respiratory Infections and Inflammations with CC
MS-DRG 179 — Respiratory Infections and Inflammations without CC/MCC

The DRG ultimately assigned in the inpatient setting is highly dependent on the principal diagnosis (which in most cases is the underlying condition that necessitated the tracheostomy and the current hospitalization), the presence of CCs and MCCs, and the specific PCS code assigned. Patients with established tracheostomies are frequently critically ill, and the encounter will commonly pair with high-weight MCCs such as respiratory failure (J96.00), sepsis (A41.x), or major organ dysfunction, pushing DRG weight upward significantly.

Additionally, if the patient has a tracheostomy on mechanical ventilation for more than 96 hours, the encounter may group to the very high-weight ECMO/Tracheostomy DRGs (003, 004) regardless of what other procedures were performed, making the bronchoscopy a secondary coding consideration in terms of DRG impact.

wRVU and Reimbursement

Work RVU (wRVU): 2.09
Global Period: 0 days
2025 Medicare Conversion Factor: $32.35
Approximate 2025 Medicare Facility (Hospital/ASC) Payment: ~ $132 -$ 145
Approximate 2025 Medicare Non-Facility Payment: ~$186
Anesthesia Code Crosswalk: 00520 (Anesthesia for procedures on trachea and bronchi; not otherwise specified) — 5 base units

The wRVU of 2.09 reflects a moderately complex diagnostic endoscopic procedure. By comparison, a standard diagnostic bronchoscopy via the mouth or nose (CPT 31622) carries a wRVU of 2.53, which is higher because transoral access requires navigation of the upper airway and is technically more demanding. The lower wRVU of 31615 reflects the relative ease of scope insertion through the established stoma, though the diagnostic and interpretive work involved is otherwise comparable.

The 0-day global period means that all pre-procedure evaluation and post-procedure monitoring on the same date of service is included in the single payment. Subsequent encounters — for example, a follow-up bronchoscopy the next day or a clinical visit the following week — are separately billable.

Assistant Surgeon

CPT 31615 has an assistant surgeon indicator of 0 under Medicare — meaning that assistant surgery is not permitted and will not be reimbursed. This procedure is a single-operator endoscopic examination that does not typically require a second operative surgeon. A trained bronchoscopy technician, respiratory therapist, or nurse may assist at the bedside, but their role is not that of an assistant surgeon and does not support assistant surgeon billing. Commercial payers generally follow the same convention.

HCC Relevance

CPT 31615 itself does not carry direct HCC mapping. The procedure code is a service, not a diagnosis. However, the diagnosis codes commonly associated with 31615 in the inpatient and outpatient settings do carry significant HCC implications:

J96.00 (Acute Respiratory Failure) — maps to HCC 84 (Cardiorespiratory Failure and Shock), a high-weight HCC with significant impact on risk-adjusted payments.
C34.x (Lung Cancer) — maps to HCC 9 (Lung and Other Severe Cancers), one of the highest-weight HCC categories.
J44.1 (COPD with Acute Exacerbation) — maps to HCC 111 (Chronic Obstructive Pulmonary Disease), a moderately weighted HCC.
J18.9 / J22 (Pneumonia) — not HCC-mapped directly, but secondary complications and respiratory failure arising from pneumonia do carry HCC weight.
Z93.0 (Tracheostomy status) — not an HCC code by itself, but flags a patient as medically complex and is often accompanied by multiple comorbidities that are HCC-relevant.
Z99.11 (Ventilator dependence) — not HCC-mapped directly, but when combined with underlying diagnoses, confirms a clinically complex profile.

For outpatient risk-adjustment purposes, capturing all relevant comorbid diagnoses during encounters where 31615 is performed is essential. Tracheostomy patients are frequently medically complex, and thorough diagnosis reporting at each encounter contributes meaningfully to accurate risk adjustment.

CPT 31615 sits within the broader bronchoscopy and trachea endoscopy family. Understanding where it fits relative to other codes is critical for accurate code selection.

Trachea and Bronchi Endoscopy — CPT 31600-31661 │ 
├── TRACHEOSTOMY CREATION (not endoscopy — listed for context) │ 
├── 31600 — Tracheostomy, planned (separate procedure) │ 
├── 31601 — Tracheostomy, planned; younger than 2 years │ 
├── 31603 — Tracheostomy, emergency; transtracheal │ 
└── 31605 — Tracheostomy, emergency; cricothyroid membrane │ 
├── TRACHEOSCOPY (laryngoscopy family — see 31515-31578) │ 
└── NOTE: Tracheoscopy alone uses laryngoscopy codes, NOT 31615 │ 
├── TRACHEOBRONCHOSCOPY │ 
└── 31615 — Tracheobronchoscopy through ESTABLISHED tracheostomy ← THIS CODE 

│ (0-day global; wRVU 2.09; scope inserted via pre-existing stoma) │ 
├── STANDARD BRONCHOSCOPY (transoral or transnasal — NOT through trach) │ 
├── 31622 — Bronchoscopy, diagnostic with cell washing (separate procedure) │ 
│ wRVU 2.53 │ 
           ├── 31623 — Bronchoscopy with brushing or protected brushings │ 
           │ wRVU 2.63 │ 
           ├── 31624 — Bronchoscopy with bronchial alveolar lavage (BAL) │
           │ wRVU 2.63 │ 
	       ├── 31625 — Bronchoscopy with bronchial or endobronchial biopsy(s) │ 
	       │ wRVU 3.11 │
                     ├── 31626 — Bronchoscopy with placement of fiducial markers │ 
                     ├── 31628 — Bronchoscopy with transbronchial lung biopsy, single lobe │ 
                     ├── 31629 — Bronchoscopy with transbronchial needle aspiration │ 
                     ├── 31630 — Bronchoscopy with tracheal/bronchial dilation or closed reduction │ 
                     ├── 31631 — Bronchoscopy with placement of tracheal stent │ 
                     ├── 31632 — Bronchoscopy with transbronchial lung biopsy, each add'l lobe (add-on) │ 
                     ├── 31635 — Bronchoscopy with removal of foreign body │ 
                     ├── 31636 — Bronchoscopy with endobronchial stent placement, each additional stent (add-on) │ 
                     ├── 31638 — Bronchoscopy with revision of tracheal or bronchial stent │ 
                     ├── 31640 — Bronchoscopy with excision of tumor │ 
                     ├── 31641 — Bronchoscopy with therapeutic intervention for emphysema │ 
                     ├── 31643 — Bronchoscopy with therapeutic aspiration of contrast material (catheter) │ 
                     ├── 31645 — Bronchoscopy with therapeutic aspiration of tracheobronchial tree, initial │ 
                     └── 31646 — Bronchoscopy with therapeutic aspiration, each additional (add-on) │ 
                        ├── EBUS (Endobronchial Ultrasound) │ 
                        ├── 31652 — Bronchoscopy with EBUS for transtracheal/transbronchial sampling, 1-2 stations │ 
                        ├── 31653 — Bronchoscopy with EBUS for transtracheal/transbronchial sampling, 3+ stations │ 
                        └── 31654 — Transendoscopic ultrasound during bronchoscopy for peripheral lesion(s) (add-on) │ 
                        └── ADD-ON CODE PERMITTED WITH 31615 
                        └── 31627 — Computer-assisted pulmonary navigation for bronchoscopic procedures (add-on) (Approved for use with 31615 per CPT guidelines)

Includes / What This Code Covers

Flexible or rigid bronchoscopy performed exclusively through an established, previously created tracheostomy stoma
Both diagnostic (visualization only) and minor incidental therapeutic maneuvers encountered during the examination, such as suctioning of secretions in the course of the scope passage
Examination of the trachea from the tracheostomy site distally, including inspection of the carina, right main bronchus, left main bronchus, and lobar/segmental bronchi to the extent of scope advancement
Procedures performed with or without sedation — the code applies regardless of anesthetic approach
Procedures performed in any setting — inpatient bedside, ICU, operating room, procedure suite, or ASC
The complete diagnostic bronchoscopy interpretation when performed by the same physician performing 31615. Per CPT surgical bronchoscopy guidelines, surgical bronchoscopy always includes the diagnostic component when performed by the same physician.

Excludes / What This Code Does NOT Cover

Standard transoral/transnasal bronchoscopy (31622-31651) — if the scope is passed through the mouth or nose (not through the tracheostomy), 31615 is not applicable even if a tracheostomy is present and not used for scope access.
Tracheoscopy alone — if only the trachea is inspected without advancing into the bronchi, tracheoscopy is reported using the appropriate laryngoscopy codes in the 31515-31578 range, not 31615. The descriptor “tracheobronchoscopy” implies that the bronchi were entered. If documentation does not confirm advancement into the bronchi, consider whether 31615 is truly supported.
Bronchoscopy performed at the time of fresh tracheostomy creation — if the tracheostomy was created in the same operative session immediately prior to the bronchoscopy, the tracheostomy is not yet “established” and 31615 would not be appropriate. The bronchoscopy in that scenario may be incidental (used to confirm tube placement) and typically not separately reportable.
Discrete therapeutic interventions beyond incidental suctioning — if a biopsy is taken (31625 equivalent), brushings are obtained (31623 equivalent), BAL is performed (31624 equivalent), or any other distinct therapeutic maneuver is performed, these should be reported with the appropriate companion code (not through 31615 alone). However, note that there are no direct bronchoscopy-via-trach equivalents of these interventional codes — the convention is to report 31615 as the access code and pair it with the appropriate bronchoscopic intervention code, using a modifier (typically -59 or -XS) to indicate a distinct service, per payer policy.
EBUS through a tracheostomy — if EBUS is used during the procedure, 31652, 31653, or 31654 would be additionally applicable, but these require separate documentation and cannot be assumed from 31615 alone.
Computer-assisted navigation — add-on code 31627 may be reported in addition to 31615 when electromagnetic navigation bronchoscopy guidance is used, but 31615 alone does not include this service.
Tracheostomy tube changes — tube change alone without bronchoscopy is not reported with 31615. Tracheostomy tube changes are either a bundled service or reported using appropriate tube supply codes (A7520, A7521) separately.

NCCI Edits and Bundling Considerations

31615 and standard bronchoscopy codes (31622-31651): Per NCCI edits, if a transoral bronchoscopy is performed in the same session as 31615, these would be mutually exclusive or at minimum subject to careful review. Performing bronchoscopy through two different access routes in the same session is clinically uncommon and would require compelling documentation.
31615 and laryngoscopy codes (31575 etc.): These two code families are considered sequential procedures and should not be billed together in the same session by the same provider without strong documentation of a distinct, separate clinical purpose for each examination.
31615 and 31627 (computer-assisted navigation): This pairing is explicitly sanctioned in CPT guidelines — 31627 is a listed add-on permitted with 31615.
Incidental suctioning / secretion clearance: When routine suctioning of mucus is performed as part of the scope passage during 31615, it is included in 31615 and cannot be separately reported. Only when therapeutic aspiration is the primary goal (and substantial therapeutic effort is documented) would consideration of a separate aspiration code be clinically supported.
31615 performed within the global period of a tracheostomy code (31600, 31603, etc.): Tracheostomy codes carry a 90-day global period. If a 31615 is performed during that global period by the same surgeon who created the tracheostomy, payers may consider it bundled into the global period of the original procedure unless it is for an unrelated indication, in which case Modifier -79 applies. If performed by a different physician, there is no global period conflict and 31615 can be reported normally.

Modifiers

-52 (Reduced Services) — If the bronchoscopy is not completed (e.g., scope cannot be advanced past the trachea due to anatomic obstruction or patient intolerance), Modifier 52 should be appended to indicate reduced services. The documentation must clearly explain why the procedure was not completed.
-53 (Discontinued Procedure) — If the procedure is started but discontinued before any diagnostic or therapeutic objective is achieved due to a patient complication (e.g., desaturation, bleeding), Modifier 53 applies.
-59 (Distinct Procedural Service) — Applied to 31615 when billed alongside a companion bronchoscopic intervention code (biopsy, BAL, etc.) to indicate that both services are distinct and separately reportable.
-XS (Separate Structure) — Medicare preferred alternative to Modifier 59 in some contexts; may be applicable when 31615 is billed alongside a companion procedure code addressing a different anatomic level.
-51 (Multiple Procedures) — May be applied to secondary procedures when 31615 is billed alongside another procedure in the same operative session.
-79 (Unrelated Procedure During Postoperative Period) — Applied when 31615 is performed during the 90-day global period of the tracheostomy procedure (31600, 31603, etc.) by the same surgeon, for a reason unrelated to the original surgical indication.
-76 (Repeat Procedure by Same Physician) — If 31615 must be repeated on the same date of service by the same physician (e.g., emergent repeat bronchoscopy for acute recurrent occlusion), Modifier 76 allows the claim to pass through duplicate claim edits.
-26 (Professional Component) — Not applicable; 31615 has no technical/professional component split.

Documentation Requirements

Accurate assignment of CPT 31615 requires that the operative or procedure note contain the following elements:

Route of access — explicit statement that the scope was inserted through the established tracheostomy stoma, not through the mouth or nose. The note must use language such as “bronchoscope was introduced through the established tracheostomy,” or equivalent phrasing.
Confirmation that the tracheostomy was pre-existing — the note should reference a previously placed tracheostomy, not one created in the same session.
Scope of visualization — documentation of which structures were directly inspected (trachea, carina, right main bronchus, left main bronchus, specific lobar/segmental bronchi). “The tracheobronchial tree was inspected bilaterally to the segmental level” is sufficient; generic language like “bronchoscopy was performed” is inadequate.
Findings — all abnormal and relevant normal findings must be documented: mucosal appearance, presence of secretions, granulation tissue, tracheomalacia, bleeding, tumors, foreign bodies, or any other observed pathology.
Interventions performed — if any discrete therapeutic interventions were performed (BAL, biopsy, aspiration, foreign body removal), these must be specifically documented to support companion code reporting.
Indication / medical necessity — the clinical indication for the procedure (the reason the physician performed the bronchoscopy) must be clearly stated and must correlate with the assigned diagnosis code.
Operator and facility — physician name, credentials, and place of service must be documented.

A procedure note that only states “bronchoscopy through trach — normal airway” provides access route and findings but lacks the visualization scope detail and clear indication required for optimal supportable coding and medical necessity.

Coding Examples

Example 1 — Standard Diagnostic Bronchoscopy Through Established Tracheostomy A ventilator-dependent ICU patient with a tracheostomy placed 12 days prior develops increasing secretions and a new left lower lobe infiltrate. The pulmonologist performs a tracheobronchoscopy through the established tracheostomy, inspecting the trachea, carina, right and left main bronchi, and bilateral lobar bronchi. Thick purulent secretions are encountered in the left lower lobe segment. Suction is applied via the scope to clear the secretions. No biopsy is taken. Bronchoscopy specimens are sent to microbiology.

Code: 31615 Diagnoses (primary): J98.11 (Atelectasis), J18.9 (Pneumonia, unspecified organism) Secondary: Z93.0 (Tracheostomy status), Z99.11 (Dependence on respirator), J96.01 (Acute respiratory failure with hypoxia) Note: Routine suctioning performed in the course of the bronchoscopy is included in 31615. No companion code for the suctioning is warranted here because it was incidental to visualization. If the primary purpose of the bronchoscopy had been therapeutic airway clearance rather than diagnostic inspection, 31645 (therapeutic aspiration) could have been considered instead.

Example 2 — Bronchoscopy with Biopsy Through Established Tracheostomy A patient with a known tracheal mass and established tracheostomy (placed 3 weeks prior for airway protection) undergoes tracheobronchoscopy. The physician inspects the trachea and finds a 1.5 cm polypoid lesion on the posterior tracheal wall with irregular mucosal margins. Two biopsies are taken from the lesion using cup forceps passed through the working channel.

Codes: 31615, 31625-59 Diagnoses: D38.1 (Neoplasm of uncertain behavior of trachea, bronchus and lung), Z93.0 (Tracheostomy status) Note: 31625 reports the biopsy component. Modifier 59 on 31625 indicates it is a distinct procedural service beyond the diagnostic examination captured by 31615. Payer-specific guidance should be reviewed — some payers may require Modifier XS in lieu of or in addition to Modifier 59 for this combination.

Example 3 — Bronchoscopy with BAL Through Established Tracheostomy An immunocompromised patient with a mature tracheostomy develops fever and bilateral infiltrates. Bronchoalveolar lavage is performed through the established tracheostomy to collect diagnostic specimens for suspected pneumocystis pneumonia.

Codes: 31615, 31624-59 Diagnoses: J17 (Pneumonia in diseases classified elsewhere — if PCP is documented), B59 (Pneumocystosis), Z93.0, Z99.11 Note: 31624 (BAL) is reported alongside 31615. The BAL is a distinct therapeutic/diagnostic service beyond the scope inspection itself.

Example 4 — Bronchoscopy with Computer-Assisted Navigation Through Established Tracheostomy A patient with a known right lower lobe peripheral nodule and a long-term tracheostomy undergoes electromagnetic navigation bronchoscopy through the established stoma to attempt biopsy of the peripheral lesion. Navigation is used to guide the catheter to the lesion. Transbronchial biopsy is performed.

Codes: 31615, 31628-59, 31627 (add-on) Diagnoses: D14.31 (Benign neoplasm of right bronchus and lung), Z93.0 Note: 31627 is an explicitly permitted add-on code with 31615. 31628 (transbronchial lung biopsy, single lobe) captures the biopsy component and is reported with Modifier 59.

Example 5 — Incorrect Code Selection Scenario A patient with a known tracheostomy presents for outpatient flexible bronchoscopy. The physician opts to perform the bronchoscopy transorally (through the mouth) rather than through the tracheostomy because the stoma has partially narrowed and the standard tracheostomy tube has been removed. The scope is passed through the mouth past the vocal cords and down into the trachea and bronchi.

Correct Code: 31622 (Bronchoscopy, diagnostic, with cell washing) or the appropriate transoral bronchoscopy code — NOT 31615 Rationale: The access route matters. 31615 is only appropriate when the scope is passed through the established tracheostomy stoma. If transoral or transnasal access is used — even in a patient who has a tracheostomy — the standard bronchoscopy codes (31622-31651) apply. This is a commonly observed miscoding scenario.

Example 6 — Inpatient Coder Scenario (ICD-10-PCS) The same patient in Example 1 is admitted inpatient. The pulmonologist performs the tracheobronchoscopy at bedside on hospital day 3. The inpatient coder does not use CPT codes.

ICD-10-PCS Code: 0BJ18ZZ — Inspection of Trachea, Via Natural or Artificial Opening Endoscopic Principal Diagnosis: J18.9 (Pneumonia, unspecified organism) Secondary Diagnoses: J98.11, Z93.0, Z99.11, J96.01 DRG Consideration: Because 0BJ18ZZ is classified as a non-OR procedure in the MS-DRG grouper, this bronchoscopy alone will not trigger a surgical DRG. The case will group as a medical DRG based on the principal diagnosis — likely MS-DRG 193 (Simple Pneumonia and Pleurisy with MCC) or MS-DRG 177 (Respiratory Infections and Inflammations with MCC) depending on the presence of MCC qualifiers.

Coding Pitfalls and Common Errors

Using 31615 when the scope was passed transorally in a trach patient: The most common error. Always confirm access route from the operative note. The presence of a tracheostomy does not automatically mean it was used as the scope entry point.
Using standard bronchoscopy codes (31622-31646) instead of 31615 when access was via the tracheostomy: The reverse error also occurs. If the op note says “scope introduced through the tracheostomy stoma,” 31622 or 31625 alone is incorrect — 31615 is the appropriate base code.
Failing to separately report companion intervention codes: 31615 captures the diagnostic bronchoscopy-equivalent service through the tracheostomy, but discrete therapeutic interventions (BAL, biopsy, dilation) should be captured separately with the appropriate codes and a Modifier 59 or XS. Not capturing these additional services results in undercoding and revenue loss.
Reporting 31615 during the global period of the tracheostomy without proper modifier: If the same surgeon who created the tracheostomy (90-day global) performs 31615 during that window for a related indication, the service is included in the global period and should not be separately billed. If for an unrelated indication, Modifier 79 must be appended.
Confusing tracheoscopy and tracheobronchoscopy: Tracheoscopy (visualization limited to the trachea) is not reported with 31615; it falls under the laryngoscopy code family (31515-31578). CPT 31615 requires that the scope advance into the bronchi.
Inpatient coders assigning CPT codes: In the inpatient setting, CPT codes are not used. All procedures must be assigned ICD-10-PCS codes. Assigning 31615 as a procedure code in an inpatient UB-04 claim is an error and will typically reject or trigger an audit.
Missing Z93.0 and Z99.11 in diagnosis reporting: These status codes add important clinical context and should always be reported as secondary diagnoses in encounters where the patient’s established tracheostomy and/or ventilator dependence are relevant to the clinical picture. These codes are not HCC-mapped but contribute to complete and accurate clinical documentation.

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31615