Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus
CPT4 code
Name of the Procedure:
Bronchoscopy, rigid or flexible (includes fluoroscopic guidance when performed) with placement of bronchial stent(s), initial bronchus. This procedure may also include tracheal/bronchial dilation as required.
Summary
Bronchoscopy is a procedure where a tube-like instrument called a bronchoscope is inserted through the nose or mouth into the airways of the lungs to diagnose and treat various conditions. This particular procedure involves placing stents in the bronchial passages to keep them open, which may also require dilation of the airways.
Purpose
This procedure is primarily used to keep the airways open in patients who have obstructions due to tumors, strictures, or other medical conditions. The goals are to improve breathing, relieve symptoms associated with airway blockages, and prevent complications like pneumonia.
Indications
- Obstructions in the airways from tumors or growths
- Narrowing of the trachea or bronchi (strictures) due to scarring or inflammation
- Failed previous treatments for airway obstruction
- Need for airway dilation due to blockages
Preparation
- Patients may be instructed to fast 6-8 hours before the procedure.
- Medication adjustments might be necessary, particularly with blood thinners.
- Pre-procedural diagnostic tests such as chest X-rays, CT scans, or pulmonary function tests.
- A pre-procedural consultation to discuss the process, risks, and benefits.
Procedure Description
- The patient is given local anesthesia and possibly sedation or general anesthesia.
- A bronchoscope (rigid or flexible) is gently inserted through the nose or mouth into the trachea and bronchial passages.
- Fluoroscopic guidance may be used to precisely navigate the bronchoscope.
- If necessary, dilation is performed to widen the airways.
- Stents are placed in the bronchial passages to keep them open.
- The bronchoscope is removed carefully, and post-procedure monitoring follows.
Duration
The procedure generally takes between 30 minutes to 2 hours, depending on complexity.
Setting
Performed in a hospital, usually in a specialized procedure room (bronch suite), or an operating room.
Personnel
- Pulmonologists or thoracic surgeons
- Anesthesiologists (if general anesthesia is used)
- Nurses trained in bronchoscopy support and care
- Radiologists (if fluoroscopic guidance is used)
Risks and Complications
Common Risks:
- Bleeding
- Infection
- Fever
Rare Risks:
- Airway injury
- Pneumothorax (collapsed lung)
- Allergic reactions to anesthesia or medications
Benefits
- Immediate improvement in breathing
- Relief from symptoms such as wheezing and coughing
- Prevention of complications such as pneumonia by ensuring open airways
Recovery
- Post-procedure monitoring for a few hours for any immediate complications.
- Instructions may include avoiding strenuous activity and follow-up appointments for assessment.
- Recovery time varies, but most patients can resume normal activities within a few days.
Alternatives
- Medical management with medications like bronchodilators and corticosteroids.
- Less invasive procedures such as balloon dilation without stent placement.
- Surgery, in severe cases where less invasive measures are not effective.
Pros and Cons:
- Medications and less invasive procedures might have fewer immediate risks but might be less effective long-term.
- Surgery is more invasive with longer recovery, but might be necessary for severe conditions.
Patient Experience
During the procedure, patients might feel pressure but not pain if under local anesthesia and sedation. General anesthesia ensures the patient is asleep. Post-procedure, there might be some throat soreness and mild discomfort, which can be managed with pain relief measures.