CPT® Code 31661

1. Indications

The procedure of bronchial thermoplasty, as described by CPT® Code 31661, is indicated for patients suffering from severe, persistent asthma that is not well controlled with conventional treatments, including inhaled corticosteroids and long-acting beta-agonists. This procedure is specifically aimed at those individuals who experience significant asthma symptoms and exacerbations despite optimal medical management.

• Severe Persistent Asthma Patients with asthma that remains uncontrolled despite the use of inhaled corticosteroids and long-acting beta-agonists.

2. Procedure

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. At this stage, the physician will assess the airways for any abnormalities that may be present. If a rigid bronchoscope is utilized, a telescope or flexible bronchoscope can be inserted through it to provide enhanced visualization of the distal segments of each mainstem bronchus. Following this initial assessment, 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 device is activated to deliver low-power, temperature-controlled radiofrequency (RF) energy to the airway wall for a maximum duration of 10 seconds at each targeted location. This RF energy application heats the airway wall, effectively destroying excessive smooth muscle tissue, which contributes to the airway's ability to constrict and narrow. After the initial treatment, the electrodes are repositioned and activated along all accessible airways that are distal to the mainstem bronchus within the lobe being treated. It is important to note that for treatment of one lobe in a single session, CPT® Code 31660 should be used, while CPT® Code 31661 is designated for the treatment of two or more lobes in a single session. Typically, multiple bronchial thermoplasty sessions are required, as only a portion of the lungs (1-2 lobes) can be treated during each session.

3. Post-Procedure

After the bronchial thermoplasty procedure, patients may experience some degree of discomfort or transient respiratory symptoms, which are generally manageable. It is essential for healthcare providers to monitor patients for any immediate post-procedure complications. Patients are typically advised on follow-up care and may require additional sessions to achieve optimal results, as the procedure is designed to treat only a limited number of lobes at a time. The overall recovery process may vary depending on the individual patient's response to the treatment and the extent of the procedure performed.