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A lung transplant is a surgical procedure in which a single lung is replaced with a healthy lung from a donor. This operation is typically indicated for patients suffering from severe lung diseases that have not responded to other treatments. The procedure involves opening the thoracic cavity through a posterolateral incision, usually made between the fourth or fifth intercostal space, to gain access to the lung. In some cases, the fifth rib may be excised to improve visibility and access. If the use of cardiopulmonary bypass is necessary, an additional incision may be made in the groin to facilitate the connection of the bypass machine to the thoracic vessels. During the transplant, the lung with the poorest function is removed from the recipient, and the donor lung is carefully placed into the thoracic cavity. Various techniques may be employed for the transplant, including different methods for connecting the bronchus, pulmonary artery, and pulmonary vein. The bronchial anastomosis involves suturing the smaller bronchus into the larger one, and this site is often reinforced with surrounding tissue to ensure stability. The pulmonary arteries and veins are then anastomosed to restore blood flow to the new lung. After the transplant, the lung is reinflated, and any air trapped in the pulmonary vasculature is evacuated. The surgical site is meticulously closed, and the bronchial anastomosis is inspected to ensure proper healing. This procedure is coded as CPT® 32852 when performed with cardiopulmonary bypass, highlighting the complexity and critical nature of the operation.
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The lung transplant procedure is indicated for patients with severe pulmonary conditions that significantly impair lung function and quality of life. These conditions may include:
The lung transplant procedure involves several critical steps to ensure the successful replacement of the diseased lung with a healthy donor lung. The process begins with the patient being placed under general anesthesia. The thorax is then opened through a posterolateral incision, typically made between the fourth or fifth intercostal space. In some cases, the fifth rib may be excised to provide better access to the lung. If cardiopulmonary bypass is required, a second incision may be made in the groin to facilitate the cannulation of thoracic vessels. 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. Various techniques may be employed for the anastomosis of the bronchus, pulmonary artery, and pulmonary vein, and these may be performed in a different order than described. The bronchial anastomosis is accomplished by telescoping the smaller bronchus into the larger bronchus and suturing them together. This site is reinforced with local peribronchial tissue, thymic tissue pedicle flaps, or pericardial fat to ensure stability. Following this, the donor and recipient pulmonary arteries are approximated to avoid kinking and are then anastomosed. 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 before the pulmonary vein orifices are anastomosed. After the lung is reinflated, air is evacuated from the pulmonary vasculature at the left atrial suture line, and lung perfusion is reestablished. The suture lines are evaluated and reinforced as necessary. Chest tubes are placed as needed to facilitate drainage, and the chest is subsequently closed. Finally, the bronchial anastomosis is inspected using flexible bronchoscopy to clear the airway of blood and secretions.
Post-procedure care following a lung transplant is critical for ensuring the success of the surgery and the health of the patient. Patients are typically monitored in an intensive care unit (ICU) for several days following the operation to manage any complications and ensure stable recovery. Common post-operative care includes monitoring vital signs, managing pain, and preventing infection. Patients may require immunosuppressive medications to prevent rejection of the donor lung. Regular follow-up appointments are essential to assess lung function and overall health. Rehabilitation programs may also be initiated to help patients regain strength and improve their respiratory function. The use of chest tubes may continue until fluid drainage stabilizes, and the surgical site is closely monitored for any signs of complications such as bleeding or infection. Overall, the post-procedure phase is crucial for the long-term success of the lung transplant.
| Short Descr | LUNG TRANSPLANT WITH BYPASS | Medium Descr | LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS | Long Descr | Lung transplant, single; with 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 |
This is a primary code that can be used with these additional add-on codes.
| 34714 | Addon Code MPFS Status: Active Code APC N ASC N1 Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34716 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure) | 34833 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure) |
| 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. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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. | 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). | CR | Catastrophe/disaster related | 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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| 1994-01-01 | Added | First appearance in code book in 1994. |
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