How To Use CPT Code 32853

CPT 32853 describes the surgical procedure of lung transplant, specifically the replacement of both lungs with healthy lungs from a cadaver or living donor. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 32853?

CPT 32853 is used to report the surgical procedure of lung transplant, specifically the replacement of both lungs with healthy lungs from a cadaver or living donor. This code is used when the procedure is performed without the use of cardiopulmonary bypass.

2. Official Description

The official description of CPT code 32853 is: ‘Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass.’

3. Procedure

1. The surgical team prepares the patient and places monitoring lines.
2. The provider performs a bilateral thoracosternotomy, also known as a clamshell incision, to provide broad chest exposure.
3. The right lung is removed by dividing the right mainstem bronchus, pulmonary artery, and pulmonary veins at the most distal level.
4. The provider supports the patient by ventilating the left lung using a double-lumen endotracheal tube.
5. The cold preserved allograft lung is placed into the chest, and the provider resects the patient’s mainstem bronchus, pulmonary artery, and pulmonary veins to accommodate the transplant.
6. An end-to-end anastomosis is performed to connect the patient’s respective structures to the donor structures, including the pulmonary artery, mainstem bronchus, and left atrial cuffs.
7. The provider may use soft tissue from near the bronchus to cover the anastomosis and close the area.
8. Chest tubes are inserted, and a bronchoscopy may be performed to clear remaining blood and mucus from the new lungs.
9. The chest is closed, and the patient is ventilated and extubated according to standard requirements.

4. Qualifying circumstances

CPT 32853 is used when a lung transplant procedure is performed without the use of cardiopulmonary bypass. This procedure is typically performed on patients with end-stage lung disease who require a double lung transplant.

5. When to use CPT code 32853

CPT code 32853 should be used when a lung transplant procedure is performed without the use of cardiopulmonary bypass. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 32853, the following documentation is required:

• Patient’s medical history and indication for lung transplant
• Details of the surgical procedure, including the approach used and any specific techniques employed
• Documentation of the use of cardiopulmonary bypass (if applicable)
• Any additional procedures performed during the same operative session
• Any complications or unexpected findings encountered during the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 32853, it is important to accurately document the details of the procedure and ensure that it was performed without the use of cardiopulmonary bypass. This code should not be reported with other lung transplant codes that involve different techniques or the use of cardiopulmonary bypass. It is recommended to review the specific guidelines provided by the payer to ensure accurate billing.

8. Historical information

CPT 32853 was added to the Current Procedural Terminology system on January 1, 1994. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient with end-stage lung disease undergoes a lung transplant procedure without the use of cardiopulmonary bypass.
2. A provider performs a double lung transplant on a patient using lungs from a living donor, without the use of cardiopulmonary bypass.
3. A patient with cystic fibrosis receives a bilateral sequential lung transplant without the use of cardiopulmonary bypass.
4. A provider performs a lung transplant procedure on a patient with pulmonary fibrosis, replacing both lungs with healthy lungs from a cadaver donor, without the use of cardiopulmonary bypass.
5. A patient with chronic obstructive pulmonary disease undergoes a double lung transplant procedure without the use of cardiopulmonary bypass.
6. A provider performs a lung transplant on a patient with idiopathic pulmonary arterial hypertension, replacing both lungs with healthy lungs from a living donor, without the use of cardiopulmonary bypass.
7. A patient with bronchiectasis receives a bilateral sequential lung transplant without the use of cardiopulmonary bypass.
8. A provider performs a double lung transplant procedure on a patient with interstitial lung disease, using lungs from a cadaver donor, without the use of cardiopulmonary bypass.
9. A patient with alpha-1 antitrypsin deficiency undergoes a lung transplant without the use of cardiopulmonary bypass.
10. A provider performs a double lung transplant on a patient with pulmonary hypertension, replacing both lungs with healthy lungs from a living donor, without the use of cardiopulmonary bypass.