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The procedure described by CPT® Code 33935 involves a heart-lung transplant, which is a complex surgical operation that entails the removal of the patient's diseased heart and lungs and their replacement with healthy donor organs. The surgery begins with a median sternotomy, which is an incision made along the sternum to provide access to the thoracic cavity. Cardiopulmonary bypass is then established, allowing the surgeon to temporarily take over the function of the heart and lungs during the procedure. This is crucial as it maintains blood circulation and oxygenation while the organs are being replaced. During the transplant, care is taken to preserve the phrenic nerves, which are essential for diaphragm function and breathing. If an orthotopic heart transplant is performed, the entire lung structure is removed along with most of the heart, leaving parts of the recipient's atria intact. The surgical steps include making incisions in the right atrium and the left atrium, connecting these incisions, and preparing the recipient's anatomy for the insertion of the donor organs. The donor heart and lungs are then carefully positioned, and the trachea of both the donor and recipient are connected to ensure proper airway function. Finally, the donor aorta is anastomosed to the recipient aorta, and the patient is gradually weaned off the cardiopulmonary bypass. The procedure concludes with the placement of chest tubes to drain any fluid and the closure of the chest incisions. This intricate operation is performed to treat patients with end-stage heart and lung diseases, providing them with a chance for improved health and quality of life.
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The heart-lung transplant procedure described by CPT® Code 33935 is indicated for patients suffering from severe, end-stage cardiopulmonary diseases. These conditions may include, but are not limited to, the following:
The heart-lung transplant procedure involves several critical steps, each essential for the successful replacement of the patient's diseased organs with healthy donor organs. The procedure begins with a median sternotomy, where the surgeon makes an incision along the sternum to access the thoracic cavity. Following this, cardiopulmonary bypass is established, which temporarily takes over the function of the heart and lungs, allowing the surgical team to operate on a still and bloodless field. Next, the removal of the diseased heart and lungs is performed with great care to preserve the phrenic nerves, which are crucial for diaphragm movement and breathing. If an orthotopic heart transplant is indicated, the entire lung structure is excised along with most of the heart, while leaving the posterior aspects of the recipient's right atrium or both atria intact. The surgical team then proceeds to open the right atrium of the recipient heart along the atrioventricular groove, extending the incision to the coronary sinus and the right atrial appendage. The aorta and main pulmonary artery are subsequently divided at the valve commissures, and the roof of the left atrium is incised between the aorta and the superior vena cava. These atrial incisions are then connected and extended to the left atrial appendage, facilitating the insertion of the donor organs. Once the recipient's anatomy is adequately prepared, the donor heart and lungs are inserted into the thoracic cavity. The next step involves the anastomosis of the donor and recipient trachea to ensure proper airway function. Following this, the donor heart is anastomosed to the remaining portion of the recipient's atria, and the donor aorta is connected to the recipient aorta, completing the vascular connections necessary for organ function. Finally, the patient is weaned off cardiopulmonary bypass, chest tubes are placed to manage any postoperative fluid accumulation, and the chest incisions are closed, marking the completion of the procedure.
After the heart-lung transplant procedure, patients typically require close monitoring in an intensive care unit (ICU) setting to ensure stable recovery. Post-procedure care includes managing pain, monitoring for signs of infection, and ensuring proper function of the transplanted organs. Patients may also need to undergo immunosuppressive therapy to prevent organ rejection, which is a critical aspect of post-transplant care. The expected recovery period can vary, but patients are generally advised to follow a structured rehabilitation program to regain strength and improve overall health. Regular follow-up appointments are essential to monitor the function of the transplanted organs and adjust medications as necessary.
| Short Descr | TRANSPLANTATION HEART/LUNG | Medium Descr | HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC | Long Descr | Heart-lung transplant with recipient cardiectomy-pneumonectomy | Status Code | Restricted Coverage | 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) | P2F - Major procedure, cardiovascular-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.
| 33924 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (List separately in addition to code for primary procedure) | 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. | 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. | 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. | 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). | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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