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A lung transplant is a surgical procedure that involves the replacement of a diseased or damaged lung with a healthy lung from a donor. Specifically, a single lung transplant refers to the transplantation of one lung, which is typically performed when one lung is severely compromised while the other lung remains functional. The procedure is conducted through an incision in the thorax, allowing the surgeon to access the lung directly. The incision is usually made in the fourth or fifth intercostal space, and in some cases, the fifth rib may be excised to improve access to the lung. This operation is performed without the use of cardiopulmonary bypass, which means that the patient's heart and lungs continue to function normally during the surgery. The surgeon removes the lung with the poorest pulmonary function and replaces it with the donor lung, which is then carefully connected to the recipient's bronchial and vascular structures. Various techniques may be employed during the transplant, particularly in the anastomosis of the bronchus, pulmonary artery, and pulmonary vein, which can be performed in different sequences based on the surgeon's preference and the specific circumstances of the transplant. The procedure requires meticulous attention to detail to ensure proper healing and function of the transplanted lung.
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The indications for a single lung transplant typically include severe lung diseases that significantly impair respiratory function. These conditions may include, but are not limited to:
The procedure for a single lung transplant involves several critical steps, each essential for the successful replacement of the lung. The process begins with the patient being placed under general anesthesia. The thorax is then opened through a posterolateral incision made in the fourth or fifth intercostal space. To facilitate access to the lung, the surgeon may excise the fifth rib. In certain situations, a second incision may be made in the groin to prepare for potential cardiopulmonary bypass if necessary, particularly if the thoracic vessels cannot be cannulated. Once access is achieved, the lung with the poorest pulmonary function is carefully removed from the transplant recipient. The donor lung is then positioned within the thoracic cavity. The surgical team may employ various techniques for the anastomosis of the bronchus, pulmonary artery, and pulmonary vein, which can be performed in different sequences based on the surgeon's discretion. The bronchial anastomosis is typically accomplished by telescoping the smaller bronchus into the larger bronchus and suturing them together. This site is then covered with local peribronchial tissue, thymic tissue pedicle flaps, or pericardial fat to promote healing. Following this, the donor and recipient pulmonary arteries are approximated to prevent kinking and are anastomosed. Next, the left atrium is clamped in preparation for the anastomosis of the donor and recipient pulmonary veins. The recipient pulmonary vein is incised, and a left atrial cuff is created, allowing for the anastomosis of the pulmonary vein orifices. After the lung is reinflated, air is evacuated from the pulmonary vasculature at the left atrial suture line, and lung perfusion is reestablished. The surgeon evaluates the suture lines and reinforces them with additional sutures as necessary. Chest tubes are placed to facilitate drainage, and the chest is subsequently closed. Finally, the bronchial anastomosis is inspected using flexible bronchoscopy to ensure that the airway is clear of blood and secretions.
Post-procedure care for a single lung transplant includes close monitoring of the patient in a recovery unit. The patient will typically require intensive care for several days to manage pain, monitor lung function, and prevent complications such as infection or rejection of the donor lung. Chest tubes may remain in place for a few days to drain any excess fluid or air from the thoracic cavity. Patients will also undergo regular assessments, including imaging studies and pulmonary function tests, to evaluate the success of the transplant. Immunosuppressive medications will be initiated to prevent organ rejection, and the patient will need to adhere to a strict follow-up schedule with their healthcare team to monitor for any signs of complications and to manage their overall health post-transplant.
| Short Descr | LUNG TRANSPLANT SINGLE | Medium Descr | LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS | Long Descr | Lung transplant, single; without cardiopulmonary bypass | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 2 - Team surgeons permitted; pay by report. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 176 - Other organ transplantation |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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