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Bronchial thermoplasty is a specialized medical procedure aimed at treating severe, persistent asthma in patients who do not achieve adequate control with standard inhaled corticosteroids and long-acting beta-agonists. This procedure involves the use of a bronchoscope, which can be either rigid or flexible, to access the airways. The bronchoscope is introduced through the patient's nose or mouth and is guided into the oropharynx, with fluoroscopic guidance utilized as necessary to ensure accurate placement. Once the bronchoscope reaches the trachea, it is further advanced into either the right or left mainstem bronchus. During this process, any abnormalities within the airways are carefully noted. If a rigid bronchoscope is employed, a telescope or flexible bronchoscope may be inserted through it to allow for visualization of the distal segments of each mainstem bronchus. The procedure specifically targets the airway walls, where a catheter containing a thermoplasty device is introduced and positioned at the first treatment site, typically the most distal airway within the targeted lobe. An electrode array is then placed against the airway wall, and the device is activated to deliver low-power, temperature-controlled radiofrequency (RF) energy. This energy is applied for a maximum of 10 seconds at each location, effectively heating the airway wall to destroy excessive smooth muscle tissue. This reduction in smooth muscle mass decreases the airways' ability to constrict and narrow, which is a significant factor in asthma exacerbations. The electrodes are systematically repositioned and activated along all accessible airways distal to the mainstem bronchus within the lobe being treated. It is important to note that this code, 31660, is specifically used for the treatment of one lobe in a single session, while 31661 is designated for the treatment of two or more lobes in a single session. Typically, multiple bronchial thermoplasty sessions are necessary, as only a portion of the lungs (1-2 lobes) can be treated during each session.
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The procedure of bronchial thermoplasty is indicated for patients with severe, persistent asthma that remains poorly controlled despite the use of inhaled corticosteroids and long-acting beta-agonists. This treatment is specifically designed for individuals who experience significant asthma symptoms and exacerbations, which can severely impact their quality of life and daily functioning.
The bronchial thermoplasty procedure begins with the introduction of a bronchoscope, which can be either rigid or flexible, through the patient's nose or mouth. The bronchoscope is carefully advanced into the oropharynx, and fluoroscopic guidance may be utilized to ensure proper positioning. Once the bronchoscope reaches the trachea, it is further advanced into the right or left mainstem bronchus. During this process, the physician will observe and document any abnormalities present in the airways. If a rigid bronchoscope is used, a telescope or flexible bronchoscope may be inserted through it to visualize the distal segments of each mainstem bronchus more effectively. Following this, a catheter containing the thermoplasty device is introduced through the bronchoscope and positioned at the first target treatment site, which is typically the most distal airway within the targeted lobe. An electrode array is then placed against the wall of the airway, and the thermoplasty device is activated. Low-power, temperature-controlled radiofrequency (RF) energy is delivered to the airway wall for a maximum of 10 seconds at each location. This RF energy heats the airway wall, destroying excessive smooth muscle tissue, which in turn reduces the airways' ability to constrict and narrow. After the initial application, the electrodes are repositioned and activated along all accessible airways distal to the mainstem bronchus within the lobe being treated. This systematic approach allows for comprehensive treatment of the targeted lobe.
After the bronchial thermoplasty procedure, patients may experience some degree of discomfort or transient side effects, which can include coughing, wheezing, or shortness of breath. It is essential for healthcare providers to monitor patients closely following the procedure to manage any immediate post-procedural symptoms. Patients are typically advised on post-procedure care, which may include the use of bronchodilators or other medications to alleviate any discomfort. Additionally, follow-up appointments are necessary to assess the effectiveness of the treatment and to determine if further sessions are required, as multiple sessions may be needed to treat all affected lobes of the lungs. The overall recovery process may vary among patients, and ongoing evaluation of asthma control is crucial to ensure optimal management of their condition.
| Short Descr | BRONCH THERMOPLSTY 1 LOBE | Medium Descr | BRONCHOSCOPIC THERMOPLASTY ONE LOBE | Long Descr | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8F - Endoscopy - bronchoscopy | MUE | 1 | CCS Clinical Classification | 42 - Other OR therapeutic procedures on respiratory system |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2013-01-01 | Added | Added |
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