Bronchoscopy w/treatment of bleeding with lidocaine

rebeccadyke84

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Local Chapter Officer
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Huntington, Indiana
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Hello, I've never seen this before. During a bronch, the doc injected lidocaine with epinephrine and thrombin to stop bleeding in the lung. Would this fall under the alveolar lavage? Here is the report:

PROCEDURE: Bronchoscopy with local treatment of areas of active bleeding with lidocaine epinephrine mixture as well as thrombin injection.
INDICATION: History of small-cell lung cancer as he had active hemoptysis for the last 2 weeks.

FINDINGS: After moderate sedation was achieved with fentanyl and Versed, the bronchoscope was inserted into the oropharynx. The vocal cords moved a little bit sluggishly but appeared to abduct and abduct appropriately. Entered the trachea. There were no abnormalities. The right tracheobronchial tree was examined first. There were no abnormalities noted. There was blood coming directly from the left mainstem bronchus. The left mainstem bronchus at about the 9 o'clock position had what appeared to be large endobronchial tumor, which was actively bleeding. I was able to navigate past the left mainstem bronchus tumor and evaluate the left upper division, which appeared to have a slit-like confirmation, and I was unable to advanced my scope into this area. This area was bleeding as well. It was nonpulsatile in nature and nonmassive in nature. I then flexed in the left lower lobe. It was anatomically normal, howwever, it was studded with what appeared to be patches of tumor. These areas were actively bleeding. I chose at that point to withdraw to the level of the left mainstem bronchus and instill lidocaine with epinephrine mixture. Following that, I injected 2 cc of thrombin at the level of left mainstem bronchus. I advanced the scope to the first carina and injected 2 more cc of thrombin. There appeared to be very good hemostasis following this injection.

Any ideas?? Thanks
 

sjtrew

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Greater Pittsburgh Chapter
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Hi - i have the same situation ....... during a bronch with brushings, washings and bronchial bx, the surgeon injected thrombin into an area that was noted to have a slow continuous oozing (pt presented with hemoptysis). is this injection separately billable?
thanks for your time and help!
 

fwnewbie

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New Haven, IN
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The bleeding was present before the scope was inserted so I think it should go under injection for control of bleeding. Alveolar lavage would be instilling/rinsing the air sacs and the scope didn't go that far and no rinsing fluid was instilled.
As for the bleeding caused by the brushings, washing, and bronchial tx, if it follows the same rules as GI endoscopy, the control of bleeding due to the procedure is not billed separately but is written into the code for the procedure.
 
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