Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fracture
CPT4 code
Name of the Procedure:
Bronchoscopy, Rigid or Flexible (also known as tracheobronchoscopy, bronchoscopic dilation, or bronchofibroscopy) Including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fracture.
Summary
Bronchoscopy is a procedure that allows doctors to look directly at the airways in the lungs using a thin, flexible or rigid tube called a bronchoscope. The tube is inserted through the nose or mouth and moved down the throat into the lungs. The procedure can also include the use of X-ray guidance (fluoroscopy) to assist in procedures like dilation of narrowed airways (tracheal/bronchial dilation) or the non-surgical setting of fractured airways (closed reduction of fracture).
Purpose
Bronchoscopy is performed to diagnose or treat conditions affecting the airways or lungs. The goals of the procedure are to open narrowed airways, remove blockages, take tissue samples, or repair fractures within the airway structures.
Indications
- Persistent cough
- Unexplained lung issues or infections
- Suspected tumors or growths in the airways
- Foreign objects lodged in the airways
- Airway strictures or stenosis (narrowing)
- Airway fractures needing non-surgical repair
Preparation
- Patients are often instructed to fast for 6-12 hours before the procedure.
- Medications may need to be adjusted or paused as per the doctor's instructions.
- Pre-procedure tests like chest X-rays, blood tests, or CT scans may be required.
- Arrange for transportation, as sedation used during the procedure can make it unsafe to drive.
Procedure Description
- Sedation/Anesthesia: Local anesthesia or moderate sedation is administered to keep the patient comfortable. In some cases, general anesthesia may be used, particularly for rigid bronchoscopy.
- Insertion: The bronchoscope is gently inserted through the nose or mouth and passed down the throat into the airways.
- Fluoroscopic Guidance: X-ray guidance may be used to navigate the bronchoscope and ensure precision.
- Dilation or Fracture Reduction: If dilation is needed, special tools are used to widen the narrowed parts of the airways. If reducing a fracture, the bronchoscope may be used to realign the structures.
- Sample Collection: Tissue samples or secretions may be collected for further analysis.
- Conclusion: The bronchoscope is gently removed, and the patient is monitored until the effects of sedation wear off.
Duration
The procedure typically takes between 30 minutes to 2 hours, depending on the complexity of the situation.
Setting
Bronchoscopies are usually performed in a hospital, specifically in a procedure room or operating room, but may also be done in specialized outpatient clinics.
Personnel
- Pulmonologist or Thoracic Surgeon
- Anesthesiologist (if general anesthesia is used)
- Nursing staff
- Radiology technician (if fluoroscopy is used)
Risks and Complications
- Bleeding
- Infection
- Pneumothorax (collapsed lung)
- Throat irritation or hoarseness
- Adverse reactions to anesthesia or sedation
Benefits
- Relief from breathing difficulties due to narrowed airways
- Accurate diagnosis of lung conditions
- Non-surgical repair of airway fractures
- Removal of blockages or foreign bodies
- Improvement in overall respiratory function
Recovery
- Patients are usually monitored for several hours post-procedure.
- Mild throat soreness or cough may be experienced.
- Avoid driving or operating heavy machinery for 24 hours if sedated.
- Follow-up appointments may be necessary to monitor recovery and evaluate treatment outcomes.
- Rest and avoid strenuous activities for a few days.
Alternatives
- Medical therapy such as inhalers or oral medications for less severe cases.
- Imaging tests (e.g., CT scans) for non-invasive diagnosis.
- Surgical intervention if bronchoscopy is not feasible or fails.
- Each alternative has its pros and cons based on the specific condition and patient's overall health.
Patient Experience
During the procedure, patients are typically sedated and may not feel discomfort. Post-procedure, some throat soreness or coughing might occur, but pain management strategies and comfort measures are provided to ensure a smooth recovery. Most patients can return to normal activities within a few days.