CAM 70145

Endoscopic Laser for Tracheobronchial Obstructions

Category:Surgery   Last Reviewed:March 2020
Department(s):Medical Affairs   Next Review:March 2999
Original Date:March 1996    

Description:
A laser can be used endoscopically to resect tracheobronchial obstructions. The laser fibers are directed to the obstruction by either a rigid bronchoscope or a flexible fiberscope. The laser then uses light and heat energy to coagulate tissue and remove the obstruction.


Policy:
The use of an endoscopic laser is considered MEDICALLY NECESSARY in treating obstructions of the trachea or either right or left main bronchus.


The use of an endoscopic laser in treating obstructions of the segmental or lobar bronchi is considered INVESTIGATIONAL.

Coding Section

Codes Number Description
CPT 31641 Bronchoscopy, with destruction of tumor or relief of stenosis by any method other than excision
ICD-9 Procedure 32.01 Endoscopic excision or destruction of lesion or tissue of bronchus (Note: There is no “endoscope” specific code for “Trachea”)
ICD-9 Diagnosis  012.8 Other specified respiratory tuberculosis
  095.8

Other specified forms of late symptomatic syphilis

Note: 095.8, 012.8 are listed in the ICD-9 Index as causes of tracheobronchial obstructions. They may or may not apply

  162.0 Malignant neoplasm of trachea (primary)
  162.2 Malignant neoplasm main bronchus (primary)
  197.0 Secondary malignant neoplasm lung (bronchus)
  197.3 Secondary malignant neoplasm other respiratory organs (trachea)
  212.2 Benign neoplasm of trachea
  212.3 Benign neoplasm bronchus and lung
  231.1 Carcinoma in situ of trachea
  231.2 Carcinoma in situ bronchus and lung
  235.7 Neoplasm of uncertain behavior trachea, bronchus, and lung
  239.1 Neoplasm of unspecified nature respiratory system
  519.1 Other diseases of trachea and bronchus NEC
  748.3 Other anomalies of larynx, trachea, and bronchus
HCPCS No Code  
ICD-10-CM (effective 10/01/15)  A158  Other respiratory tuberculosis
  A5273  Symptomatic late syphilis of other respiratory organs
  A5276  Other genitourinary symptomatic late syphilis
  A5279  Other symptomatic late syphilis
  C33  Malignant neoplasm of trachea
  C3400  Malignant neoplasm of unspecified main bronchus
  C7800  Secondary malignant neoplasm of unspecified lung
  C7839  Secondary malignant neoplasm of other respiratory organs
  D142  Benign neoplasm of trachea
  D1430  Benign neoplasm of unspecified bronchus and lung
  D021  Carcinoma in situ of trachea
  D0220  Carcinoma in situ of unspecified bronchus and lung
  D381  Neoplasm of uncertain behavior of trachea, bronchus and lung
  D491  Neoplasm of unspecified behavior of respiratory system
  J9801  Acute bronchospasm
  J398  Other specified diseases of upper respiratory tract
  J9809  Other diseases of bronchus, not elsewhere classified
  Q311  Congenital subglottic stenosis
  Q313  Laryngocele
  Q318  Other congenital malformations of larynx
  Q321  Other congenital malformations of trachea
  Q324  Other congenital malformations of bronchus
ICD-10-PCS (effective 10/01/15)  0B534ZZ  Destruction of Right Main Bronchus, Percutaneous Endoscopic Approach
  0B538ZZ  Destruction of Right Main Bronchus, Via Natural or Artificial Opening Endoscopic
  0B544ZZ  Destruction of Right Upper Lobe Bronchus, Percutaneous Endoscopic Approach
  0B548ZZ  Destruction of Right Upper Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
  0B554ZZ  Destruction of Right Middle Lobe Bronchus, Percutaneous Endoscopic Approach
  0B558ZZ  Destruction of Right Middle Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
  0B564ZZ  Destruction of Right Lower Lobe Bronchus, Percutaneous Endoscopic Approach
  0B568ZZ  Destruction of Right Lower Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
  0B574ZZ  Destruction of Left Main Bronchus, Percutaneous Endoscopic Approach
  0B578ZZ  Destruction of Left Main Bronchus, Via Natural or Artificial Opening Endoscopic
  0B584ZZ  Destruction of Left Upper Lobe Bronchus, Percutaneous Endoscopic Approach
  0B588ZZ  Destruction of Left Upper Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
  0B594ZZ  Destruction of Lingula Bronchus, Percutaneous Endoscopic Approach
  0B598ZZ  Destruction of Lingula Bronchus, Via Natural or Artificial Opening Endoscopic
  0B5B4ZZ  Destruction of Left Lower Lobe Bronchus, Percutaneous Endoscopic Approach
  0B5B8ZZ  Destruction of Left Lower Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
  0BB34ZZ  Excision of Right Main Bronchus, Percutaneous Endoscopic Approach
  0BB38ZZ  Excision of Right Main Bronchus, Via Natural or Artificial Opening Endoscopic
  0BB44ZZ  Excision of Right Upper Lobe Bronchus, Percutaneous Endoscopic Approach
  0BB48ZZ  Excision of Right Upper Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
  0BB54ZZ  Excision of Right Middle Lobe Bronchus, Percutaneous Endoscopic Approach
  0BB58ZZ  Excision of Right Middle Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
  0BB64ZZ  Excision of Right Lower Lobe Bronchus, Percutaneous Endoscopic Approach
  0BB68ZZ  Excision of Right Lower Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
  0BB74ZZ  Excision of Left Main Bronchus, Percutaneous Endoscopic Approach
  0BB78ZZ  Excision of Left Main Bronchus, Via Natural or Artificial Opening Endoscopic
  0BB84ZZ  Excision of Left Upper Lobe Bronchus, Percutaneous Endoscopic Approach
  0BB88ZZ  Excision of Left Upper Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
  0BB94ZZ  Excision of Lingula Bronchus, Percutaneous Endoscopic Approach
  0BB98ZZ  Excision of Lingula Bronchus, Via Natural or Artificial Opening Endoscopic
  0BBB4ZZ  Excision of Left Lower Lobe Bronchus, Percutaneous Endoscopic Approach
  0BBB8ZZ  Excision of Left Lower Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
Type of Service Surgery  
Place of Service Inpatient/Outpatient  

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

03/02/2020 

Annual review. No change to policy intent. 

03/04/2019 

Annual Review. No change to policy intent. 

03/19/2018 

Annual Review. No change to policy intent. 

03/02/2017 

Annual review.  No change to policy intent 

03/10/2016

Annual review.  No change to policy intent.

09/21/2015 

Added ICD-10 codes. 

03/05/2015 

Annual review. No change to policy intent. Added coding.

03/3/2014

Annual review. No changes made.


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