A flexible bronchoscope was then introduced in the LMA. The patient's vocal cords were examined and noted to be functional and moving symmetrically. The patient's trachea was normal. The carina was normal. The left-sided main bronchus and segments were all normal. The right-sided main bronchus was normal. The right upper lobe bronchus was normal and its segments as well. The bronchus intermedius was noted to be normal and at its very distal area where the right middle lobe bronchus separates from the right lower lobe, there was noted to be some mild extrinsic compression. The right superior segment bronchus was definitively compressed and slit like but still open. The flexible bronchoscope was then removed
These were sampled with endobronchial ultrasound fine needle aspiration needles. All of these passes returned good lymphoid tissue but no malignant cells were noted. The endobronchial ultrasound was advanced further and the right hilum was examined with ultrasound.
31629(Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed, with tranbronchial needle aspiration biopsy[s]).
the endobronchial ultrasound bronchoscope was placed.Ultrasound was then used to examine the paratracheal lymph nodes.
+31620 (Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic interventions. [List separately in addition to code for primary procedure)
The bronchoscope was positioned carefully in the bronchus intermedius and the right lower lobe mass itself was identified and a fine needle aspiration needle was placed into the right lower lobe mass. This biopsy confirmed nonsmall cell lung carcinoma. Additional passes were made to assist in obtaining enough tissue for further diagnostic work. The endobronchial ultrasound was then removed.
+31633 (with transbronchial needle aspiration biopy[s], each additional lobe [List separately in addition to code for primary procedure]).
Multiple 10R lymph nodes were observed. These were sampled with the fine needle aspiration needles and noted also to have good lymphoid tissue but no malignant cells.
10022 (Fine needle aspiration with imaging guidance)
I would not use code 38505 because that would be an opened superficial biopsy.
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