CPT® Code 0251T | Case2Code

Code deleted, use 31647-31649

Official Description

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe

Common Language Description

The procedure described by CPT® Code 0251T involves the removal of bronchial valve(s) from the initial lobe of the lungs, utilizing either a rigid or flexible bronchoscope. A bronchial valve is a device implanted in the airways to manage conditions such as emphysema, but it may need to be removed due to complications or insufficient patient benefit. The bronchoscope is a specialized instrument that allows for direct visualization and access to the airways, and it can be inserted through the nose or mouth. Once in place, the bronchoscope is navigated through the oropharynx and trachea, reaching the right or left mainstem bronchus. Fluoroscopic guidance may be employed during this process to enhance visualization and ensure accurate placement. The procedure involves careful examination of the bronchial structures, where the valve and its surrounding tissues are assessed. The central rod of the valve is then grasped with biopsy forceps, leading to the valve's collapse, which facilitates its removal. After the valve is extracted, the bronchoscope is reinserted to inspect the segmental or subsegmental bronchus for any signs of injury, followed by a thorough examination of the bronchi, trachea, and oropharynx. This procedure is specifically coded as 0251T for the removal of one or more valves from a single lobe, while 0252T is designated for the removal of valves from each additional lobe.

1. Indications

The procedure described by CPT® Code 0251T is indicated for patients who have bronchial valves that need to be removed due to specific complications or a lack of benefit from the device. The following conditions may warrant this procedure:

Complications from Bronchial Valves The presence of adverse effects or complications arising from the implanted bronchial valves, which may include obstruction, infection, or other respiratory issues.
Lack of Patient Benefit Situations where the bronchial valves are not providing the intended therapeutic benefits, leading to continued or worsening respiratory symptoms.

2. Procedure

The procedure for the removal of bronchial valve(s) as per CPT® Code 0251T involves several critical steps:

Step 1: Preparation and Anesthesia The patient is prepared for the procedure, which may involve administering local anesthesia or sedation to ensure comfort during the bronchoscopy.
Step 2: Insertion of the Bronchoscope A rigid or flexible bronchoscope is inserted through the patient's nose or mouth. The bronchoscope is carefully advanced through the oropharynx and into the trachea, navigating towards the right or left mainstem bronchus.
Step 3: Fluoroscopic Guidance Fluoroscopic guidance may be utilized to enhance visualization of the bronchial structures, ensuring accurate placement of the bronchoscope within the airways.
Step 4: Visualization of the Bronchial Valve The bronchoscope is advanced into the segmental or subsegmental bronchus that contains the bronchial valve. The valve and surrounding structures are visualized and evaluated for any abnormalities or complications.
Step 5: Grasping the Valve The central rod of the bronchial valve is grasped using biopsy forceps. This action causes the valve to collapse, facilitating its removal from the bronchial passage.
Step 6: Removal of the Valve The collapsed valve is then carefully removed from the bronchial tree, ensuring minimal trauma to the surrounding tissues.
Step 7: Post-Removal Examination After the valve is removed, the bronchoscope is reinserted into the segmental or subsegmental bronchus to examine the area for any signs of injury or complications resulting from the valve's presence.
Step 8: Withdrawal and Final Examination The bronchoscope is withdrawn, and a thorough examination of the bronchi, trachea, and oropharynx is conducted to ensure there are no residual issues or complications.

3. Post-Procedure

Post-procedure care following the removal of bronchial valve(s) includes monitoring the patient for any immediate complications, such as bleeding or respiratory distress. Patients may be observed for a period to ensure stable vital signs and adequate oxygenation. Instructions regarding activity restrictions, potential symptoms to watch for, and follow-up appointments should be provided. The healthcare team may also assess the need for further interventions or treatments based on the patient's condition following the procedure.

Short Descr	REMOV BRONCHIAL VALVE
Medium Descr	REMOVAL BRONCHIAL VALVE INITIAL LOBE
Long Descr	Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple 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)	0 - 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.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Discontinued Code
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	41 - Other non-OR therapeutic procedures on respiratory system