Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), each additional lobe (List separately in addition to code
CPT4 code
Name of the Procedure:
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, assessment of air leak, airway sizing, and insertion of bronchial valve(s), each additional lobe.
Summary
A bronchoscopy is a medical procedure where a doctor inserts a thin tube called a bronchoscope through the nose or mouth and into the lungs. This procedure may involve balloon occlusion, measuring the airways, assessing leaks, and placing small valves in the bronchial passages using fluoroscopic guidance (real-time X-ray imaging).
Purpose
The purpose of the procedure is to diagnose or treat conditions affecting the lungs and airways. It is used to control air leaks, measure airway size, and place bronchial valves to improve airflow.
Indications
- Persistent air leaks in the lungs
- Chronic obstructive pulmonary disease (COPD)
- Severe asthma not responsive to other treatments
- Emphysema
- Evaluation of lung abnormalities detected on imaging studies
- Patients needing precise airway measurements
Preparation
- Fasting (no eating or drinking) for several hours before the procedure
- Adjusting certain medications as advised by the healthcare provider
- Pre-procedure diagnostic tests like blood work, chest X-ray, or pulmonary function tests
Procedure Description
- The patient is sedated or given general anesthesia.
- A bronchoscope, either rigid or flexible, is inserted through the nose or mouth.
- Fluoroscopic guidance is used to navigate the bronchoscope.
- A balloon may be inflated within the airway to occlude or block it temporarily.
- Air leaks are assessed, and the size of the airways is measured.
- Bronchial valves are inserted into the appropriate lobes of the lungs.
- The bronchoscope is removed, and the patient is monitored during recovery.
Duration
The procedure typically takes between 30 minutes to 2 hours, depending on the complexity.
Setting
It is performed in a hospital, usually in an endoscopy suite or an operating room equipped with fluoroscopic imaging.
Personnel
- Pulmonologist or thoracic surgeon
- Nurses and respiratory therapists
- Anesthesiologist or sedation specialist
- Radiology technologist (if fluoroscopic guidance is used)
Risks and Complications
- Bleeding
- Infection
- Pneumothorax (collapsed lung)
- Adverse reactions to anesthesia
- Airway perforation (rare)
- Valve displacement or malfunction
Benefits
- Relief from symptoms like shortness of breath
- Improved lung function
- Resolution of air leaks
- Enhanced quality of life
- Benefits may be realized shortly after the procedure
Recovery
- Post-procedure monitoring for a few hours
- Instructions on activity restrictions and wound care
- Medications to manage pain or discomfort
- Follow-up appointments to monitor progress and valve placement
Alternatives
- Conservative management with medications
- Non-invasive ventilation or oxygen therapy
- Surgical interventions like lung volume reduction surgery
- Each alternative has its own risks and benefits, often compared based on patient-specific factors
Patient Experience
- Mild discomfort during the procedure, usually managed with sedation or anesthesia
- Sore throat, cough, or minor chest pain post-procedure
- Pain management may include prescribed medications or over-the-counter pain relievers
- Most patients can return to normal activities within a few days, with specific follow-up and care instructions provided.