CPT® Code 31775

1. Indications

The bronchoplasty procedure, specifically CPT® Code 31775, is indicated for patients experiencing significant bronchial stenosis, which can lead to compromised airflow and respiratory function. The following conditions may warrant this surgical intervention:

• Bronchial Stenosis - A condition characterized by the narrowing of the bronchus, which can result from various causes such as trauma, infection, or congenital abnormalities.
• Obstructive Airway Disease - Conditions that lead to obstruction in the airways, causing difficulty in breathing and reduced lung capacity.
• Post-Transplant Complications - Stenosis may occur in patients who have undergone lung transplantation, necessitating surgical correction to restore normal airway function.

2. Procedure

The procedure for CPT® Code 31775 involves several critical steps to ensure successful excision of the stenotic segment and subsequent anastomosis of the bronchus:

• Step 1: Incision and Exposure - An anterior intercostal incision is made, which is then extended around the chest to the scapula. This approach allows for adequate exposure of the lung and bronchus. A rib spreader may be utilized to facilitate access, and in some cases, a rib may be removed to enhance visibility and maneuverability during the procedure.
• Step 2: Lung Deflation and Bronchus Exposure - The lung is deflated to provide a clear view of the bronchus. The surgeon identifies the stenotic segment, which is the narrowed portion of the bronchus that needs to be excised.
• Step 3: Excision of Stenotic Segment - The bronchus is carefully mobilized and clamped above and below the stenosis. The narrowed segment is then divided and removed, ensuring that healthy bronchial tissue remains for anastomosis.
• Step 4: Anastomosis - Traction sutures are placed at the midlateral positions of the proximal and distal bronchial segments to facilitate approximation and reduce tension during suturing. The two segments are then sutured together, and any discrepancies in circumference are addressed by creating small folds (plicating) in the segment with the wider diameter.
• Step 5: Reinforcement and Closure - The anastomosis site is reinforced using pericardial fat or pleura to provide additional support. After confirming the integrity of the anastomosis, saline solution is instilled into the pleural cavity, and the lung is re-expanded. The surgical site is then checked for air leaks, and chest tubes are placed as necessary. Finally, the chest incisions are closed in layers to complete the procedure.

3. Post-Procedure

Following the bronchoplasty procedure, patients are monitored for any complications, including air leaks at the anastomosis site. The placement of chest tubes may be necessary to facilitate drainage and prevent fluid accumulation in the pleural cavity. Patients can expect a recovery period that may involve pain management and respiratory therapy to aid in lung function restoration. Regular follow-up appointments are essential to assess the healing process and ensure that the bronchial anastomosis is functioning properly. The overall goal of the procedure is to restore normal airflow and improve respiratory function, allowing patients to return to their daily activities with enhanced quality of life.