31649 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure)

Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure)

Summary

Bronchoscopy is a medical procedure that allows healthcare providers to examine the inside of the lungs, including the bronchi. This can be done using either a rigid or flexible bronchoscope. Fluoroscopic guidance may be employed during the procedure. This specific procedure involves the removal of bronchial valves from additional lobes of the lung beyond the primary treated lobe.

Purpose

The procedure addresses issues such as airway obstructions, persistent coughing, or lung collapse. The primary goal is to improve lung function and alleviate symptoms by removing bronchial valves that may be causing these issues.

Indications

• Persistent cough
• Airway obstruction
• Lung collapse (atelectasis)
• Respiratory distress not resolved by medication

Preparation

• Fasting: Patients may need to abstain from eating or drinking for at least six hours before the procedure.
• Medication Adjustments: Certain medications may need to be paused or adjusted.
• Diagnostic Tests: Pre-procedure imaging tests like X-rays or CT scans, and blood tests.

Procedure Description

1. Anesthesia: The patient is given sedation or general anesthesia.
2. Bronchoscopy: A bronchoscope (rigid or flexible) is inserted through the patient's mouth or nose to reach the lungs.
3. Fluoroscopic Guidance: Imaging technology is used to guide the bronchoscope to the targeted lobe.
4. Valve Removal: Tools attached to the bronchoscope are used to locate and remove the bronchial valve(s) from each additional lobe after the primary one.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the complexity and number of valves being removed.

Setting

Performed in a hospital, often in an operating room or a specialized endoscopy suite.

Personnel

• Pulmonologist or thoracic surgeon
• Anesthesiologist
• Nurses and respiratory technicians

Risks and Complications

• Common: Sore throat, minor bleeding, and discomfort
• Rare: Pneumothorax (collapsed lung), infection, significant bleeding, or adverse reactions to anesthesia

Benefits

• Improved lung function
• Symptom relief, often immediate or within a few days
• Potential avoidance of more invasive surgeries

Recovery

• Monitoring: Patients are usually monitored for a few hours post-procedure.
• Instructions: Avoid strenuous activities and follow prescribed medications.
• Follow-Up: Scheduled check-ups to monitor lung function and ensure proper healing.

Alternatives

• Medication therapy to manage symptoms
• Pulmonary rehabilitation
• Surgical resection to remove damaged lung tissue
• Each alternative has its own benefits and drawbacks, from non-invasiveness to potential efficacy.

Patient Experience

• During: Sedation ensures minimal discomfort. Patients might feel pressure but not pain.
• After: Mild throat soreness, tiredness; pain is generally managed with medications.
• Recovery: Most patients resume normal activities within a few days, barring complications.