How To Use CPT Code 0495T

CPT 0495T describes the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system by a physician or qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0495T?

CPT 0495T can be used to describe the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system. This code is used when a physician or qualified healthcare professional sets up the system, performs physiological and laboratory assessments, and monitors the lungs for up to two hours in a sterile field.

2. Official Description

The official description of CPT code 0495T is: ‘Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified health care professional, including physiological and laboratory assessment (eg, pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance and perfusate gas analysis), including bronchoscopy and X-ray when performed; first two hours in sterile field.’

3. Procedure

1. The physician or qualified healthcare professional establishes a marginal (extended) cadaver donor lung(s) organ perfusion system.
2. The system maintains the cadaver lungs in a near-living physiologic state, warm and perfused with blood.
3. The healthcare professional performs physiological and laboratory assessments to monitor the condition of the lungs, including tests such as pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance, perfusate gas analysis, bronchoscopy, and X-ray.
4. The monitoring and necessary adjustments are performed for up to two hours in a sterile field.

4. Qualifying circumstances

CPT 0495T is used for the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system. This procedure is performed by a physician or qualified healthcare professional. The code covers the physiological and laboratory assessments, including tests such as pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance, perfusate gas analysis, bronchoscopy, and X-ray. The monitoring and assessments are performed for up to two hours in a sterile field.

5. When to use CPT code 0495T

CPT code 0495T should be used when a physician or qualified healthcare professional initiates and monitors a marginal (extended) cadaver donor lung(s) organ perfusion system. This code is appropriate for the first two hours of monitoring in a sterile field. Additional hours of monitoring should be reported using the add-on code +0496T.

6. Documentation requirements

To support a claim for CPT 0495T, the physician or qualified healthcare professional must document the following information:

• The initiation of the marginal (extended) cadaver donor lung(s) organ perfusion system
• The specific physiological and laboratory assessments performed, including test results
• The duration of monitoring, up to two hours
• Any necessary adjustments made during the monitoring period
• Any additional procedures performed, such as bronchoscopy or X-ray
• Signature of the physician or qualified healthcare professional performing the service

7. Billing guidelines

When billing for CPT 0495T, ensure that the service is performed by a physician or qualified healthcare professional and includes the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system for up to two hours in a sterile field. Use the add-on code +0496T for each additional hour of monitoring. It is important to note that CPT code 0495T should not be reported if CPT codes 0496T to 0498T have already been performed in the previous seven days.

8. Historical information

CPT code 0495T was added to the Current Procedural Terminology system on January 1, 2018. It was also added to the Inpatient Only (IPO) list for Medicare reimbursement in 2018.

9. Examples

1. A physician setting up and monitoring a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours, including physiological and laboratory assessments.
2. A qualified healthcare professional performing bronchoscopy and X-ray during the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours.
3. A physician assessing pulmonary artery flow, pulmonary artery pressure, and perfusate gas analysis while monitoring a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours.
4. A qualified healthcare professional performing dynamic compliance and mean/peak and plateau airway pressure measurements during the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours.
5. A physician monitoring left atrial pressure, pulmonary vascular resistance, and X-ray results during the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours.
6. A qualified healthcare professional performing physiological and laboratory assessments, including bronchoscopy, during the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours.
7. A physician monitoring the perfusate gas analysis, dynamic compliance, and pulmonary artery pressure during the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours.
8. A qualified healthcare professional performing X-ray and pulmonary vascular resistance measurements during the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours.
9. A physician assessing mean/peak and plateau airway pressure, left atrial pressure, and bronchoscopy results while monitoring a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours.
10. A qualified healthcare professional performing physiological and laboratory assessments, including perfusate gas analysis, during the initiation and monitoring of a marginal (extended) cadaver donor lung(s) organ perfusion system for two hours.