🫁 CPT 31780 — Excision Tracheal Stenosis and Anastomosis; Cervical
Quick Reference
wRVU: 19.34 | Global Period: 090 | Assistant Payable: Potentially, subject to MPFS assistant-at-surgery indicator, medical necessity, and payer rules | Bilateral Indicator: 0
Rule: CPT 31780 is a major open airway reconstruction service for excision of cervical tracheal stenosis with anastomosis. CMS bilateral indicator 0 means the standard 150-percent bilateral adjustment does not apply; the trachea is a midline structure, so bilateral reporting is generally not clinically applicable.1
📋 Clinical Description
CPT 31780 reports open resection of a stenotic segment of the cervical trachea with reconstruction by anastomosis. The service is used when a documented narrowing compromises airway function and definitive surgical removal of the diseased tracheal segment is medically necessary. Documentation should establish the cervical location, the stenosis, the portion resected, the anastomosis performed, and the clinical reason for reconstruction. Do not substitute this code for endoscopic airway evaluation or dilation when excision and anastomosis were not performed.
The code is distinguished from 31781, which addresses excision of tracheal stenosis and anastomosis in the thoracic trachea rather than the cervical trachea. It is also more extensive than endoscopic tracheal dilation or diagnostic bronchoscopy because 31780 includes open excision of the stenotic tracheal segment and restoration of continuity by anastomosis. Code selection must follow the operative report’s documented anatomic location and completed work, not a preoperative plan or diagnosis alone.
This procedure may be performed in the following clinical contexts:
- Post-intubation tracheal stenosis — The surgeon documents a fixed cervical tracheal narrowing after prior prolonged intubation and performs open segmental resection with primary anastomosis.
- Post-tracheostomy stenosis — A patient develops symptomatic stenosis at or near a prior tracheostomy site, and the operative record supports cervical tracheal resection and reconstruction.
- Recurrent stenosis after prior endoscopic management — Repeated dilation or endoscopic treatment has not provided durable airway patency, leading to definitive open reconstruction.
- Traumatic or inflammatory tracheal scar — The operative report identifies localized cervical tracheal scarring or stenosis and documents excision with anastomosis to restore the airway.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Cervical tracheal stenosis | The narrowed segment lies in the cervical portion of the trachea and is approached through an open neck incision. The surgeon excises the pathologic segment and reapproximates healthy tracheal ends. | This is the anatomic circumstance described by 31780. The operative report should clearly support a cervical location rather than a thoracic location. |
| Thoracic tracheal stenosis | The stenotic segment is located in the intrathoracic trachea and may require a different operative exposure. The anatomic location changes code selection even when resection and anastomosis are performed. | Report 31781, rather than 31780, only when the operative documentation supports thoracic tracheal stenosis and the corresponding procedure. |
| Endoscopic stenosis management | Endoscopic procedures may evaluate, dilate, incise, inject, stent, or otherwise manage tracheal narrowing without open segmental resection and primary anastomosis. The procedure is not equivalent to open tracheal resection. | Do not report 31780 merely because stenosis was treated. Confirm that excision of the stenotic tracheal segment and anastomosis were actually completed. |
Clinical Pearl
The critical coding distinction is not simply “tracheal stenosis,” but the completed surgical work and precise tracheal location. CPT 31780 requires excision of stenosis and anastomosis in the cervical trachea. If the surgeon only evaluates or dilates the airway, select the code representing the documented endoscopic service instead. Because this is a 090-day global surgical service, postoperative care ordinarily related to the reconstruction is included.1
✅ Procedure Includes
- Open operative exposure necessary to access the documented cervical tracheal stenosis. Routine exposure is integral to the primary resection and reconstruction.
- Excision or resection of the stenotic cervical tracheal segment when performed as part of the reported service.
- Primary anastomosis of the remaining tracheal ends to restore tracheal continuity.
- Usual intraoperative assessment and management inherent to completion of the open reconstructive procedure.
- Routine postoperative services related to the procedure during the 090-day global period, unless a separately reportable circumstance is documented and payer requirements are met.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 31781 | Excision tracheal stenosis and anastomosis; thoracic | Do not report with 31780 for the same stenotic segment. Select the code that matches the documented location of the stenosis and surgical reconstruction. |
| 31622 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; diagnostic, with or without cell washing | A diagnostic bronchoscopy may be separately reportable only when it is distinct, medically necessary, and not integral to the open reconstruction. Routine intraoperative airway visualization used to perform or assess the primary operation is generally included. |
| 31630 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with tracheal or bronchial dilation, initial | Dilation is not separately reported when it is integral to completing the excision and anastomosis. Report a distinct endoscopic dilation only when documentation supports a separate service and applicable NCCI and payer requirements are met. |
| 31526 | Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn | Do not separately report diagnostic laryngoscopy or tracheoscopy when it is integral to airway assessment for the same operative encounter. Separate reporting requires a distinct indication and documentation. |
Bundling Alert
CPT 31780 carries a 090-day global period under the 2026 MPFS data reviewed. Routine follow-up care, incision care, airway surveillance, and management of expected postoperative recovery are included in the global surgical package. An E/M service during the global period requires a documented service meeting the requirements for -24 when unrelated to the original surgery; a return to the operating room for a related complication may require -78 only when all payer and documentation requirements are satisfied. Do not append a distinct-service modifier merely to bypass an edit.1
🌳 Code Tree — Surgery: Respiratory System
CPT 31600-31899 Surgery: Respiratory System
│
├── 31600-31614 Tracheostomy
│ ├── 31600 Tracheostomy, planned
│ └── 31613 Tracheostomy, planned, subsequent
│
├── 31750-31781 Repair and Reconstruction of Trachea
│ ├── 31750 Closure of tracheostomy or fistula; without plastic repair
│ ├── 31755 Closure of tracheostomy or fistula; with plastic repair
│ ├── 31775 Revision of tracheostomy scar
│ ├── ▶▶ 31780 ◀◀ Excision tracheal stenosis and anastomosis; cervical ← YOU ARE HERE (Global: 090)
│ └── 31781 Excision tracheal stenosis and anastomosis; thoracic
│
└── 31820-31899 Other Procedures on Trachea and Bronchi💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 19.34 |
| Global Period | 090 |
| Bilateral Indicator | 0 |
| Assistant Surgeon | Verify the current assistant-at-surgery indicator and payer requirements before billing |
| Co‑Surgeon | Verify the current co-surgery indicator and documentation requirements before billing |
| Team Surgery | Verify the current team-surgery indicator and documentation requirements before billing |
| PC/TC Split | 0 — Physician service; PC/TC concepts do not apply |
| Modifier -51 Exempt | Verify current MPFS multiple-procedure indicator and payer-specific processing |
| Anesthesia | Anesthesia is separately reported by the anesthesia professional when medically necessary and properly documented; do not bill it as part of CPT 31780 |
Bilateral Billing Rules
CMS bilateral indicator 0 means the usual 150-percent bilateral payment adjustment does not apply. The trachea is anatomically midline, and CPT 31780 describes a cervical tracheal reconstruction rather than a unilateral paired-organ procedure. Do not append -50 or bill -RT/-LT solely to seek bilateral payment.1
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -22 | Increased Procedural Services | Apply only when documentation shows work substantially greater than typically required, such as unusual severity, extensive scar, difficult exposure, or extraordinary operative time. The operative report must clearly support the additional work. |
| -52 | Reduced Services | Apply when the physician electively performs a reduced service and the service is not otherwise appropriately reported with a different CPT code. Documentation must identify what was reduced and why. |
| -53 | Discontinued Procedure | Apply when the procedure is started but discontinued because of extenuating circumstances or a threat to patient well-being. Do not use it when the procedure was never started or when a planned component was simply not clinically necessary. |
| -54 | Surgical Care Only | Apply when one physician performs the surgery and another physician provides the postoperative management. A transfer-of-care arrangement must be documented and payer rules must permit split global billing. |
| -55 | Postoperative Management Only | Apply when the reporting physician provides only postoperative management during the global period under an eligible transfer-of-care arrangement. The physician did not perform the surgery. |
| -56 | Preoperative Management Only | Apply only when the reporting physician provides only preoperative management under an eligible transfer-of-care arrangement. Confirm payer acceptance before use. |
| -62 | Two Surgeons | Apply only when two surgeons of different specialties each perform distinct, medically necessary portions of the same procedure and both document their work. Confirm the current MPFS co-surgery indicator and payer policy. |
| -66 | Surgical Team | Apply only for a highly complex procedure requiring a surgical team. The record must identify team members, their roles, and why team participation was medically necessary. |
| -80 | Assistant Surgeon | Apply when an eligible physician assistant at surgery is medically necessary and allowed by Medicare and the payer. The primary operative report should support the need for assistance. |
| -81 | Minimum Assistant Surgeon | Apply only when a physician provides minimal assistant-at-surgery services and the payer recognizes the modifier. It is not a substitute for routine operating-room support. |
| -82 | Assistant Surgeon When Qualified Resident Surgeon Not Available | Apply in a teaching setting only when a qualified resident surgeon is not available and all Medicare teaching-physician requirements are met. Documentation must support resident unavailability. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| J39.8 | Other specified diseases of upper respiratory tract | No | May be appropriate when the provider documents tracheal stenosis and no more specific valid 2026 ICD-10-CM code applies. The record must describe the stenosis and its anatomic site. |
| J95.03 | Malfunction of tracheostomy stoma | No | Use only when the provider documents a tracheostomy-stoma malfunction. Do not assign solely because the patient has a tracheostomy history. |
| J95.09 | Other tracheostomy complication | No | Use only for a documented tracheostomy complication not classified elsewhere. Confirm that the complication, rather than routine status, is the reason for treatment. |
| J38.6 | Stenosis of larynx | No | This code represents laryngeal, not tracheal, stenosis. It may support related airway pathology only when the provider documents laryngeal involvement; it does not establish cervical tracheal stenosis by itself. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| Z93.0 | Tracheostomy status | No | Report when a tracheostomy status is clinically relevant and documented. It does not replace coding a current complication or stenosis. |
| Z87.09 | Personal history of other diseases of the respiratory system | No | May be reported when a relevant respiratory history affects current care and is documented. It is not appropriate as the primary diagnosis for active stenosis. |
| Z98.890 | Other specified postprocedural states | No | Use only when the documented postprocedural state is relevant and no more specific status code applies. Avoid redundant status coding. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| J95.03 | Malfunction of tracheostomy stoma | No | A documented tracheostomy-related malfunction may explain the need for surgical intervention when supported by the operative and clinical record. |
| J95.09 | Other tracheostomy complication | No | Use when the provider identifies a qualifying complication and the documentation supports the causal relationship to the tracheostomy. |
| J39.8 | Other specified diseases of upper respiratory tract | No | May capture a documented tracheal stenosis when no more specific current ICD-10-CM option applies. Confirm the provider’s terminology and full clinical context. |
Coding Specificity Reminder
Code the documented etiology when known, such as a qualifying tracheostomy complication, rather than defaulting to a nonspecific airway diagnosis. Do not code a history, status, or complication without provider documentation supporting that condition at the encounter. Use only complete, billable 2026 ICD-10-CM codes; do not report category-level parent codes.2
🏥 MS‑DRG Considerations
CPT 31780 may be performed in an inpatient setting, but MS-DRG assignment is based on the ICD-10-CM diagnosis set and the ICD-10-PCS procedure reported on the inpatient claim, not the physician CPT code. Depending on the documented procedure, principal diagnosis, CC/MCC status, and other reportable conditions, a tracheal resection/reconstruction admission may group to an MS-DRG within the respiratory-system surgical hierarchy; the final grouper output controls. No national coverage determination specifically governing CPT 31780 was identified in the CMS MCD public search reviewed. CMS explains that NCDs generally do not contain claims-processing code lists, while LCD and Billing & Coding Article applicability must be checked by CPT/HCPCS code and MAC jurisdiction; for North Carolina, verify the current applicable MAC policy and article before claim submission.3
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality | |
|---|---|---|---|
| 0B110ZZ | Excision of trachea, open approach | Open | May represent open removal of a tracheal portion when the ICD-10-PCS root-operation definition of Excision is met. The inpatient coder must verify the operative report and complete body-part, approach, device, and qualifier values. |
| 0B113ZZ | Excision of trachea, percutaneous approach | Percutaneous | This is not the typical approach for CPT 31780, but is included to illustrate that PCS assignment follows the actual approach. Do not select it for an open cervical resection. |
| 0B118ZZ | Excision of trachea, via natural or artificial opening endoscopic | Endoscopic | This may describe an endoscopic excision when documented, not the open reconstruction inherent in CPT 31780. It should not be assumed as an equivalent to the CPT procedure. |
| 0B1G0ZZ | Excision of carina, open approach | Open | This is not a direct equivalent of CPT 31780 because the carina is a distinct PCS body part. Use only when the operative documentation identifies carinal excision. |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical. This section is used for most inpatient operative procedures. |
| 2 | Body System | B | Respiratory System. The trachea is classified in this PCS body system. |
| 3 | Root Operation | 1 | Excision. Excision is cutting out or off, without replacement, a portion of a body part. |
| 4 | Body Part | 1 | Trachea. The body-part value must reflect the actual site documented in the operative report. |
| 5 | Approach | 0 | Open. Open means cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. |
| 6 | Device | Z | No Device. Use only when no device remains after the procedure; verify whether a graft, stent, or other device remains. |
| 7 | Qualifier | Z | No Qualifier. A different qualifier may be required when supported by the procedure performed. |
Root Operation Comparison
- Excision removes a portion of a body part and may describe resection of a tracheal segment for stenosis. The PCS root operation is selected from the actual objective of the procedure, not the CPT title alone.
- Resection removes all of a body part; it is not automatically correct for a segmental tracheal operation. Review the PCS definitions and operative documentation before assigning the root operation.
- Replacement may be required when a biological or synthetic substitute replaces a body part. Primary end-to-end anastomosis without a replacement device does not by itself establish a Replacement root operation.
📝 Coding Examples
Example 1
Clinical Scenario:
A patient has progressive dyspnea after a prolonged prior intubation. The surgeon documents fixed cervical tracheal stenosis, performs an open neck incision, excises the stenotic tracheal segment, and completes primary end-to-end tracheal anastomosis. The procedure is completed without a separately documented, distinct endoscopic service.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31780 | The operative report supports open excision of cervical tracheal stenosis with anastomosis. The documented cervical location distinguishes the service from 31781. |
| PDx | J39.8 | May be appropriate when the provider documents tracheal stenosis and no more specific valid 2026 ICD-10-CM code applies. Verify all documentation before final code assignment. |
Note
Do not append a modifier simply because the procedure was complex. Use --22 only when the documentation demonstrates work substantially greater than usual.
Example 2
Clinical Scenario:
A patient with a prior tracheostomy has a documented tracheostomy-related complication and stenosis at the cervical tracheal site. The surgeon performs open excision of the stenotic segment and primary anastomosis. A bronchoscopy performed during the operation is used to evaluate the repair and is not documented as a separate diagnostic service with an independent indication.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31780 | The completed primary procedure is excision of cervical tracheal stenosis with anastomosis. The bronchoscopy is not separately reported when integral to the primary surgery. |
| PDx | J95.09 | May be appropriate only when the provider documents another qualifying tracheostomy complication as the condition responsible for treatment. |
| Secondary | Z93.0 | Report tracheostomy status when clinically relevant and documented; it does not substitute for coding the active complication. |
Warning
Do not separately report an integral diagnostic bronchoscopy or append --59 without documentation of a distinct service that satisfies payer and NCCI requirements.
Example 3
Clinical Scenario:
The surgeon plans cervical tracheal resection, begins the open operation, but discontinues before completing the resection and anastomosis because the patient develops an acute condition that makes continuation unsafe. The operative report details the completed work, reason for discontinuation, and patient-safety concern.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31780--53 | Modifier -53 may be considered when the physician begins but discontinues the procedure because of extenuating circumstances or a threat to patient well-being. The final claim must accurately reflect payer requirements and the actual completed work. |
| PDx | J39.8 | May be appropriate for a documented tracheal stenosis when no more specific valid 2026 ICD-10-CM code applies. |
Global period reminder
A discontinued procedure claim does not eliminate the need to follow payer-specific global-surgery and postoperative billing rules. Verify Medicare and commercial-payer processing requirements before submission.
⚠️ Common Coding Pitfalls
- Pitfall 1: Reporting 31780 for a tracheal dilation, incision, laser treatment, or endoscopic airway procedure. The code requires excision of cervical tracheal stenosis and anastomosis, not simply treatment of a narrowed airway.
- Pitfall 2: Selecting 31780 without confirming the stenosis is cervical. Thoracic tracheal stenosis with excision and anastomosis is reported with 31781 when supported by the operative documentation.
- Pitfall 3: Coding a diagnosis from clinical inference rather than provider documentation. Stenosis, tracheostomy complication, and tracheostomy status have different coding implications and should not be treated as interchangeable.
- Pitfall 4: Separately reporting bronchoscopy when it is integral to the open reconstruction. Separate reporting requires a distinct, medically necessary service that is documented independently and meets current payer edit requirements.
- Pitfall 5: Appending -50, -RT, or -LT to a midline tracheal reconstruction. CMS bilateral indicator 0 does not support the usual 150-percent bilateral adjustment for this code.1
- Pitfall 6: Billing routine postoperative E/M services during the 090-day global period. Use a global modifier only when the service meets the modifier’s requirements and the documentation supports the circumstance.
📎 Sources
1 Centers for Medicare & Medicaid Services. Medicare Physician Fee Schedule Look-Up Tool Overview and CY 2026 PFS Relative Value File resources, reviewed August 10, 2026. The 2026 PFS data reviewed for CPT 31780 show active status, 19.34 work RVUs, and a 090-day global period; final claim submission should be validated in the current CMS PFS Lookup Tool for the applicable locality and date of service.
2 Centers for Disease Control and Prevention, National Center for Health Statistics. ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026; FY 2026 ICD-10-CM code set.
3 Centers for Medicare & Medicaid Services. Medicare Coverage Database Search guidance, reviewed August 10, 2026. Check the current NCD, LCD, and associated Billing & Coding Article by CPT/HCPCS code and MAC jurisdiction; CMS notes that many code lists are maintained in Billing & Coding Articles rather than LCD text.
4 CMS. ICD-10-PCS Official Guidelines for Coding and Reporting, FY 2026, and ICD-10-PCS Tables. Final inpatient PCS assignment requires review of the complete operative record and applicable PCS definitions.
Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.