Pulmonology Coding Alert

Electromagnetic navigation bronchoscopy (ENB) is an enhancement to standard bronchoscopy procedure. ENB allows your pulmonologist to precisely navigate the bronchoscope to distal areas of the lung using a 3D reconstruction of the patient’s chest with the help of software and the patient’s chest CT.

Your pulmonologist will use ENB in the following scenarios:

• To navigate to a peripheral lesion to perform other bronchoscopic procedures such as a biopsy, aspiration or an excision
• For the precise placement of fiducial markers or catheters. Physicians  use these markers as a reference point for planning of radiation therapy or brachytherapy and to accurately deliver the treatment to a specific site

What goes on: ENB is essentially a three step process. The three phases of ENB include:

• Planning phase – During this process, your pulmonologist synchronizes the patient's chest CT with a specialized computer program to allow for a virtual bronchoscopy. He will map the pathway to the lung lesion onto the program. Your pulmonologist will do this part of the procedure well before the actual bronchoscopy procedure.
• Registration phase -- During the bronchoscopy, the patient lies on a table which allows your pulmonologist to establish an electromagnetic field. He will synchronize the anatomical landmarks found in planning phase with the image from the bronchoscope and use these details to guide the bronchoscope to the site of the lesion.
• Navigational phase – Your pulmonologist inserts a special navigational catheter into the bronchoscope and maneuvers into the lesion or near the lesion. He then inserts a biopsy forceps or a transbronchoscopic needle into the lesion to biopsy the lesion.