C7509 — Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation of pre-procedure CT imaging used for EN planning (CT scans collected and downloaded into the navigation system's software and 3-dimensional reconstruction) and registration parameters (anatomic landmarks) as described in the procedure background.
- Procedure notes describing use of the electromagnetic navigation system (e.g., navigation completed, tissue obtained, use of sensor/extended working channel, fluoroscopy/rEBUS use if applicable) to support coding +31627 / C7509-C7511.
- When applicable, documentation of attempted standard bronchoscopic access or reasons why standard bronchoscopy and transthoracic biopsy approaches are not appropriate or feasible for the specific lesion.
- Pathology/cytology results obtained from the EN-guided biopsy (or documentation of tissue obtained) to support diagnostic intent and medical necessity.
Key Coverage Criteria
- ICD-10 covered diagnoses (when selection criteria are met): R91.1 Solitary pulmonary nodule [peripheral pulmonary nodule]; R91.8 Other nonspecific abnormal finding of lung field [peripheral pulmonary nodules].
- CPT/HCPCS codes considered covered when selection criteria are met: +31627 (Bronchoscopy ... with computer-assisted, image-guided navigation); HCPCS C7509, C7510, C7511 (computer-assisted image-guided navigation bronchoscopy codes for diagnostic/cell washing, BAL, and biopsy respectively).
- Aetna considers electromagnetic navigation (EN)-guided bronchoscopy medically necessary for individuals with a peripheral pulmonary nodule that requires a pathologic diagnosis and is not accessible by standard bronchoscopy methods or by a transthoracic biopsy approach.
- CPT: +31627 — Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s]) (listed as covered if selection criteria are met)
- HCPCS: C7509 — Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed (covered if selection criteria are met)
- HCPCS: C7510 — Bronchoscopy, rigid or flexible, with bronchial alveolar lavage(s), with computer-assisted image-guided navigation, including fluoroscopic guidance when performed (covered if selection criteria are met)
2 Active Policies
AETNA-CPB-0776 — Electromagnetic Navigation-Guided Bronchoscopy
REGENCE-SUR179 — Electromagnetic Navigation Bronchoscopy
Related Codes
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