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A double lung transplant, also known as bilateral lung transplant, is a surgical procedure that involves the replacement of both lungs in a single operation. This procedure can be performed using two primary techniques: bilateral sequential or en bloc. The bilateral sequential technique is the most commonly utilized method, where each lung is transplanted one at a time. The thoracic cavity is accessed through a bilateral anterolateral incision, typically made through the fourth or fifth intercostal space, allowing the surgeon to expose the lungs adequately. In certain cases, an additional incision may be necessary in the groin area to facilitate cardiopulmonary bypass if the thoracic vessels cannot be cannulated. During the procedure, the first lung is carefully excised from the recipient, and the donor lung is subsequently placed into the thoracic cavity. Various techniques may be employed for the transplant, and the order of anastomosis—connecting the bronchus, pulmonary artery, and pulmonary vein—can vary based on the surgeon's preference and the specific circumstances of the transplant. The bronchial anastomosis involves a telescoping method where the smaller bronchus is inserted into the larger bronchus and secured with sutures. This site is then covered with local tissue to promote healing and stability. Following the bronchial connection, the donor and recipient pulmonary arteries are aligned to prevent kinking and are then anastomosed. The left atrium is clamped to prepare for the connection of the pulmonary veins, where the recipient vein is incised, and a cuff is created for the anastomosis. After the lung is reinflated and air is evacuated from the pulmonary vasculature, the perfusion is restored. The surgical team evaluates the suture lines for integrity and reinforces them as necessary. Chest tubes may be placed to facilitate drainage, and the chest is subsequently closed. A flexible bronchoscopy is performed to inspect the bronchial anastomosis and ensure the airway is clear of any obstructions. The second lung is then removed from the recipient and the second donor lung is transplanted using the same meticulous technique. If the procedure is conducted without the use of cardiopulmonary bypass, it is coded as 32853, whereas if cardiopulmonary bypass is required, the appropriate code is 32854. En bloc lung transplants, which involve a different surgical approach, necessitate the use of cardiopulmonary bypass and are performed through a pleural and pericardial window.
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The double lung transplant procedure is indicated for patients with severe pulmonary conditions that significantly impair lung function and quality of life. The following conditions may warrant this surgical intervention:
The double lung transplant procedure involves several critical steps to ensure successful transplantation. The following outlines the procedural steps:
Post-procedure care following a double lung transplant is critical for patient recovery and includes monitoring for complications such as infection, rejection, and respiratory issues. Patients are typically placed in an intensive care unit (ICU) for close observation immediately after surgery. They will require ongoing respiratory support and may need to be ventilated through the native lung during the first lung transplant and then through the newly transplanted lung while the second lung is transplanted. Patients will also be started on immunosuppressive therapy to prevent organ rejection, and regular follow-up appointments will be necessary to monitor lung function and overall health. Rehabilitation programs focusing on pulmonary rehabilitation will be initiated to help patients regain strength and improve their quality of life. Additionally, patients will be educated on signs of rejection and infection, as well as the importance of adhering to their medication regimen and follow-up care.
| Short Descr | LUNG TRANSPLANT DOUBLE | Medium Descr | LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS | Long Descr | Lung transplant, double (bilateral sequential or en bloc); 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) | 2 - 150% payment adjustment 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 |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 66 | Surgical team: under some circumstances, highly complex procedures (requiring the concomitant services of several physicians or other qualified health care professionals, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the "surgical team" concept. such circumstances may be identified by each participating individual with the addition of modifier 66 to the basic procedure number used for reporting services. | 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 | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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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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