CPT® Code 0781T

Bronchoscopy, rigid or flexible, with insertion of esophageal protection device and circumferential radiofrequency destruction of the pulmonary nerves, including fluoroscopic guidance when performed; bilateral mainstem bronchi

The procedure described by CPT® Code 0781T involves a bronchoscopy, which can be either rigid or flexible, combined with the insertion of an esophageal protection device and the circumferential radiofrequency destruction of the pulmonary nerves. This advanced technique is primarily utilized for patients suffering from moderate to severe chronic obstructive pulmonary disease (COPD). The goal of this procedure is to perform targeted lung denervation, which entails the permanent ablation of neural inputs to the lungs. By doing so, the procedure aims to reduce hyperactivity in the pulmonary system, thereby alleviating symptoms associated with COPD. The process begins with the administration of general anesthesia to ensure patient comfort and safety. A grounding electrode pad is strategically placed on the patient's skin, typically over the upper thigh, to facilitate the safe delivery of radiofrequency energy. An esophageal protection device is then inserted to safeguard the esophagus during the procedure. A flexible bronchoscope is introduced through the patient's nose or mouth, allowing access to the main bronchi of the lungs. The use of a cooling, balloon radiofrequency catheter is integral to the procedure, as it is threaded through the bronchoscope's working channel and positioned within the main bronchus. The catheter circulates coolant, inflating the balloon to ensure proper contact with the airway wall. Fluoroscopic guidance is employed to confirm the correct positioning of the electrode and to maintain a safe distance from the esophagus while delivering radiofrequency energy to ablate the vagal nerves. This meticulous approach is repeated in each quadrant of the bronchial area for comprehensive treatment, although the proximity of the esophagus may limit the number of treatments that can be safely performed. Finally, the instruments are withdrawn, and the airways are thoroughly inspected for any potential complications that may arise from the procedure.