Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage
CPT4 code
Name of the Procedure:
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage (BAL)
Summary
A bronchoscopy allows doctors to look inside the airways (bronchi) to diagnose or treat lung conditions. It uses a thin, flexible tube (bronchoscope) with a light and camera on the end. Sometimes fluoroscopic guidance (live X-ray) is used to help direct the bronchoscope. During the procedure, a bronchial alveolar lavage (BAL) can be performed to collect fluid from the lungs for analysis.
Purpose
Bronchoscopy with BAL is used to diagnose lung diseases, infections, cancer, and other conditions by visualizing the airways and collecting lung secretions. The goal is to provide a detailed assessment or obtain samples for lab testing, which can lead to accurate diagnosis and appropriate treatment.
Indications
- Persistent cough
- Unexplained wheezing or shortness of breath
- Abnormal chest X-ray or CT scan
- Suspected lung infection
- Lung cancer diagnosis or staging
- Recurrent pneumonia
- Monitoring lung transplant patients
Preparation
- Fasting for at least 6 hours before the procedure.
- Informing the doctor about all medications and allergies.
- Possible adjustments in medication, especially blood thinners.
- Pre-procedure tests like blood work or chest imaging.
Procedure Description
- Preparation: Patient is positioned, and vital signs are monitored.
- Anesthesia: Local anesthetic to numb the throat; often combined with sedation.
- Insertion: The bronchoscope is inserted through the nose or mouth, passing down into the bronchi.
- Fluoroscopic Guidance: Real-time X-ray imaging may guide the bronchoscope to the correct lung areas.
- BAL: Sterile saline is instilled into a lung segment and then suctioned out, collecting cells and fluids.
- Completion: The bronchoscope is removed, and the patient is monitored as they wake from sedation.
Duration
Typically lasts 30 to 60 minutes.
Setting
Performed in a hospital or outpatient clinic with appropriate facilities.
Personnel
- Pulmonologist or specialist performing the procedure
- Nurses assisting with patient care and preparation
- Anesthesiologist or nurse anesthetist if sedation is used
- Radiology technician if fluoroscopy is employed
Risks and Complications
- Bleeding
- Infection
- Pneumothorax (collapsed lung)
- Throat discomfort or hoarseness
- Adverse reactions to sedatives or anesthesia
Benefits
Allows for accurate diagnosis and targeted treatment of lung diseases. Results from BAL can guide treatment decisions.
Recovery
- Monitoring in recovery area until fully awake.
- Throat discomfort is common but typically resolved in a day or two.
- Follow instructions regarding eating, drinking, and activity level.
- Arrange for someone to drive you home.
- Follow-up appointments to discuss results and any further treatment.
Alternatives
- Non-invasive imaging like chest X-ray, CT scan, or MRI.
- Sputum analysis or less invasive lung function tests.
- Needle biopsy or open surgical lung biopsy for tissue samples.
Patient Experience
During the procedure, patients may feel pressure but usually no pain due to sedation. Post-procedure, some throat discomfort, mild coughing, or hoarseness can be expected. Sedation ensures comfort, but drowsiness and need for rest afterward are typical.