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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 patient with severe lung disease. 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 thorax, or chest 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 cases where cardiopulmonary bypass is necessary, an additional incision may be made in the groin to facilitate access to the thoracic vessels for cannulation. 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, including different orders of anastomosis for the bronchus, pulmonary artery, and pulmonary vein. The bronchial anastomosis involves a telescoping method where the smaller bronchus is inserted into the larger bronchus and sutured together, with the site covered by local tissue to promote healing. Following this, the donor and recipient pulmonary arteries are aligned and anastomosed to prevent kinking. The left atrium is clamped to prepare for the anastomosis of the pulmonary veins, where a cuff is created from the recipient's pulmonary vein, and the orifices are connected. Once the lung is reinflated, air is evacuated from the pulmonary vasculature, and perfusion is restored. The surgical team evaluates the suture lines, reinforcing them as necessary, and places chest tubes to facilitate drainage before closing the chest. A flexible bronchoscopy is performed to inspect the bronchial anastomosis and clear any blood or secretions. 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 performed without the need for cardiopulmonary bypass, a different CPT® code is used. In contrast, the en bloc technique, which involves transplanting both lungs as a single unit, requires cardiopulmonary bypass and is performed through a pleural and pericardial window.
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The double lung transplant procedure is indicated for patients suffering from 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, managing pain, and ensuring proper lung function. Patients are typically placed in an intensive care unit (ICU) for close observation immediately after surgery. They will require regular assessments of lung function and may need supplemental oxygen. Immunosuppressive therapy is initiated to prevent organ rejection, and patients will be monitored for signs of infection or other complications. Rehabilitation and physical therapy are essential components of recovery, helping patients regain strength and improve respiratory function. Follow-up appointments are necessary to monitor the health of the transplanted lungs and adjust medications as needed.
| Short Descr | LUNG TRANSPLANT WITH BYPASS | Medium Descr | LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS | Long Descr | Lung transplant, double (bilateral sequential or en bloc); 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) | 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 |
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) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | 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. | 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. | 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). | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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 | CR | Catastrophe/disaster related | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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