SECTION 602.15. Respiratory System Treatments and Procedures

(a) Biopsy and/or excision (removal) of lesion of larynx, vocal cords, trachea.

(1) Loss or change of voice.

(2) Swallowing or breathing difficulties.

(3) Perforation (hole) or fistula (connection) in esophagus (tube from throat to stomach).

(b) Rhinoplasty (surgery to change the shape of the nose) or nasal reconstruction with or without nasal septoplasty (surgical procedure to remove blockage in or straighten the bone and cartilage dividing the space between the two nostrils).

(1) Deformity of skin, bone or cartilage.

(2) Creation of new problems, such as perforation of the nasal septum (hole in wall between the right and left halves of the nose) or breathing difficulty.

(c) Submucous resection of nasal septum or nasal septoplasty (surgery to remove blockage in or straighten the bone and cartilage dividing the space between the two nostrils).

(1) Persistence, recurrence or worsening of the obstruction.

(2) Perforation of nasal septum (hole in the bone and/or cartilage dividing the space between the right and left halves of the nose) with dryness and crusting.

(3) External deformity of the nose.

(d) Sinus surgery/endoscopic sinus surgery.

(1) Spinal fluid leak.

(2) Visual loss or other eye injury.

(3) Numbness in front teeth and palate (top of mouth).

(4) Loss or reduction in sense of taste or smell.

(5) Recurrence of disease.

(6) Empty Nose Syndrome (sensation of nasal congestion, sensation of not being able to take in adequate air through nose).

(7) Injury to tear duct causing drainage of tears down the cheek.

(8) Brain injury and/or infection.

(9) Injury to nasal septum (the bone and cartilage dividing the space between the two nostrils).

(10) Nasal obstruction.

(e) Lung biopsy (removal of small piece of tissue from inside of lung).

(1) Air leak with pneumothorax (leak of air from lung to inside of chest causing the lung to collapse) with need for insertion of chest tube or repeat surgery.

(2) Hemothorax (blood in the chest around the lung) possibly requiring additional procedures.

(3) Hemoptysis (coughing up blood which can result in trouble breathing and the need to be placed on a ventilator or breathing machine and oxygen).

(f) Segmental resection of lung (removal of a portion of a lung).

(1) Hemothorax (blood in the chest around the lung).

(2) Abscess (infected fluid collection) in chest.

(3) Air leak with pneumothorax (leak of air from lung inside of chest causing the lung to collapse) with need for insertion of chest drainage tube into space between lung and chest wall or repeat surgery.

(4) Need for additional surgery.

(g) Thoracotomy (surgery to reach the inside of the chest).

(1) Hemothorax (blood in the chest around the lung).

(2) Abscess (infected fluid collection) in chest.

(3) Air leak with pneumothorax (leak of air from lung inside of chest causing the lung to collapse) with need for insertion of chest drainage tube into space between lung and chest wall or repeat surgery.

(4) Need for additional surgery.

(h) VATS - video-assisted thoracoscopic surgery (camera-assisted surgery to reach the inside of the chest through small incisions).

(1) Hemothorax (blood in the chest around the lung).

(2) Abscess (infected fluid collection) in chest.

(3) Air leak with pneumothorax (leak of air from lung inside of chest causing the lung to collapse) with need for insertion of chest drainage tube into space between lung and chest wall or repeat surgery.

(4) Need for additional surgery.

(5) Need to convert to open surgery.

(i) Percutaneous (puncture through the skin instead of incision) or Open (surgical incision) tracheostomy.

(1) Loss of voice.

(2) Breathing difficulties.

(3) Pneumothorax (collapsed lung) with need for insertion of chest tube.

(4) Hemothorax (blood in the chest around the lung).

(5) Scarring in trachea (windpipe).

(6) Fistula (connection) between trachea into esophagus (tube from throat to stomach) or great vessels.

(7) Bronchospasm (constriction of the airways leading to trouble breathing).

(8) Hemoptysis (coughing up blood which can result in trouble breathing and the need to be placed on a ventilator or breathing machine and oxygen).

(j) Bronchoscopy (insertion of a camera into the airways of the neck and chest).

(1) Mucosal injury (damage to lining of airways) including perforation (hole in the airway).

(2) Pneumothorax (collapsed lung) with need for insertion of chest tube.

(3) Pneumomediastinum (air enters the space around the airways including the space around the heart).

(4) Injury to vocal cords, laryngospasm (irritation/spasm of the vocal cords) or laryngeal edema (swelling of the vocal cords).

(5) Bronchospasm (constriction of the airways leading to trouble breathing).

(6) Hemoptysis (coughing up blood which can result in trouble breathing and the need to be placed on a ventilator or breathing machine and oxygen).

(k) Endobronchial valve placement (device inserted into airways in the lung that controls air movement into and out of abnormal portions of a lung).

(1) Mucosal injury (damage to lining of airways) including perforation (hole in the airway).

(2) Pneumothorax (collapsed lung) with need for insertion of chest tube.

(3) Pneumomediastinum (air enters the space around the airways including the space around the heart).

(4) Injury to vocal cords, laryngospasm (irritation/spasm of the vocal cords) or laryngeal edema (swelling of the vocal cords).

(5) Migration (movement) of the stent from its original position.

(6) Airway blockage, potentially life threatening.

(7) Stent blockage.

(8) Worsening of chronic obstructive pulmonary disease (worsening of emphysema).

(9) Respiratory failure (need for breathing tube placement with ventilator support).

(10) Bronchospasm (constriction of the airways leading to trouble breathing).

(11) Hemoptysis (coughing up blood which can result in trouble breathing and the need to be placed on a ventilator or breathing machine and oxygen).

(12) Recurrent infections.

(l) Endobronchial balloon dilatation with or without stent placement (placement of tube to keep airway open).

(1) Bronchial rupture (tearing of the airway) with need for additional surgery.

(2) Pneumothorax (collapsed lung) with need for insertion of chest tube.

(3) Pneumomediastinum (air enters the space around the airways including the space around the heart).

(4) Injury to vocal cords, laryngospasm (irritation/spasm of the vocal cords) or laryngeal edema (swelling of the vocal cords).

(5) Migration (movement) of the stent from its original position.

(6) Airway blockage, potentially life threatening.

(7) Stent blockage.

(8) Stent fracture (broken stent).

(9) Recurrent infections.

(10) Stent erosion into adjacent structures (stent wears a hole through the airway and injures nearby tissues).

(11) Hemoptysis (coughing up blood which can result in respiratory distress and the need to be placed on a ventilator or breathing machine and oxygen).

(m) Mediastinoscopy (insertion of a camera into the space behind the breastbone and between the lungs) with or without biopsy (removal of tissue).

(1) Hemorrhage (severe bleeding) requiring open surgery.

(2) Nerve injury causing vocal cord paralysis or poor function.

(3) Pneumothorax (collapsed lung).

(4) Tracheal injury (damage to the airway/windpipe).

(n) Pleurodesis (procedure to prevent fluid build-up in space between the lung and chest wall).

(1) Respiratory failure (need for breathing tube placement).

(2) Empyema (infection/pus in the space around the lung).

Source Note: The provisions of this §602.15 adopted to be effective December 26, 2023, 48 TexReg 7985