How To Use CPT Code 0496T

CPT 0496T 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 0496T?

CPT 0496T 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 maintains the organ perfusion system for cadaver lungs and performs up to an hour of monitoring following the initial two hours. The monitoring includes physiological and laboratory assessments to ensure the lungs remain in a viable state for transplantation.

2. Official Description

The official description of CPT code 0496T is: ‘Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified healthcare 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; each additional hour (List separately in addition to code for primary procedure)’

3. Procedure

1. The physician or qualified healthcare professional maintains an organ perfusion system for cadaver lungs to keep them in a near-living physiologic state.
2. The lungs are warmed and perfused with blood, rather than being kept on ice, to preserve their viability for transplantation.
3. The clinician performs physiological and laboratory assessments to monitor the condition of the lungs, 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. These assessments help ensure that the lungs remain in a sterile field and are suitable for transplantation.
5. The code covers up to an additional hour of monitoring following the initial two hours.
6. Each additional hour of monitoring should be reported separately in addition to the primary procedure code.

4. Qualifying circumstances

CPT 0496T 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 purpose of this procedure is to maintain the lungs in a viable donor state, increasing the lung donor pool by preserving lungs that may otherwise have deteriorated and become unacceptable for transplantation.

5. When to use CPT code 0496T

CPT code 0496T 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 used for each additional hour of monitoring beyond the initial two hours. It is important to use the appropriate code for the primary procedure (0495T) and report 0496T for each additional hour of monitoring.

6. Documentation requirements

To support a claim for CPT code 0496T, the physician or qualified healthcare professional must document the following information:

• The need for the initiation and monitoring of the organ perfusion system
• Specific physiological and laboratory assessments performed
• Date, start and end time of the monitoring period
• Results of the assessments, including 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
• Any interventions or adjustments made during the monitoring period
• Signature of the physician or qualified healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 0496T, ensure that the procedure is performed by a physician or qualified healthcare professional. Each additional hour of monitoring should be reported separately in addition to the primary procedure code (0495T). It is important to follow the guidelines provided by the payer regarding the use of modifiers and any specific documentation requirements.

8. Historical information

CPT code 0496T was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition. It is important to stay updated on any changes or revisions to ensure accurate reporting and billing.

9. Examples

1. A physician initiating and monitoring a marginal cadaver donor lung organ perfusion system for three additional hours.
2. A qualified healthcare professional performing physiological and laboratory assessments on a marginal cadaver donor lung organ perfusion system for two additional hours.
3. A physician monitoring the pulmonary artery flow, pulmonary artery pressure, and perfusate gas analysis of a marginal cadaver donor lung organ perfusion system for one additional hour.
4. A qualified healthcare professional performing bronchoscopy and X-ray on a marginal cadaver donor lung organ perfusion system for four additional hours.
5. A physician monitoring the mean/peak and plateau airway pressure, dynamic compliance, and pulmonary vascular resistance of a marginal cadaver donor lung organ perfusion system for five additional hours.
6. A qualified healthcare professional performing physiological and laboratory assessments on a marginal cadaver donor lung organ perfusion system for three additional hours.
7. A physician monitoring the left atrial pressure and perfusate gas analysis of a marginal cadaver donor lung organ perfusion system for two additional hours.
8. A qualified healthcare professional performing bronchoscopy and X-ray on a marginal cadaver donor lung organ perfusion system for four additional hours.
9. A physician monitoring the pulmonary artery flow, pulmonary artery pressure, and dynamic compliance of a marginal cadaver donor lung organ perfusion system for one additional hour.
10. A qualified healthcare professional performing physiological and laboratory assessments on a marginal cadaver donor lung organ perfusion system for three additional hours.