How To Use CPT Code 32854

CPT 32854 describes the surgical procedure of lung transplantation, specifically the replacement of both lungs with healthy lungs from a cadaver or living donor, using cardiopulmonary bypass. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 32854?

CPT 32854 can be used to describe the surgical procedure of lung transplantation, where both lungs are replaced with healthy lungs from a cadaver or living donor. This procedure involves the use of cardiopulmonary bypass and is typically performed to treat patients with severe lung diseases or conditions.

2. Official Description

The official description of CPT code 32854 is: ‘Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass.’

3. Procedure

1. The surgical team prepares the patient and places monitoring lines.
2. A bilateral thoracosternotomy, also known as a clamshell incision, is performed to provide broad chest exposure.
3. The provider removes the right lung by dividing the right mainstem bronchus, pulmonary veins, and pulmonary artery.
4. If necessary, cardiopulmonary bypass is initiated to support the patient’s hemodynamics and arterial saturation.
5. The provider inserts venous and arterial cannulas to establish extracorporeal circulation.
6. The left lung is ventilated using a double-lumen endotracheal tube.
7. The healthy lung is then placed into the chest, and the provider resects the patient’s mainstem bronchus, pulmonary artery, and pulmonary veins to accommodate the transplant.
8. An end-to-end anastomosis is performed to connect the patient’s structures to the donor structures, including the pulmonary artery, mainstem bronchus, and left atrial cuffs.
9. The provider may use soft tissue from near the bronchus to cover the anastomosis and close the area.
10. Chest tubes are inserted, and the procedure is repeated for the left lung if necessary.
11. Cardiopulmonary bypass is discontinued, and bronchoscopy is performed to clear remaining blood and mucus from the new lungs.
12. The chest is closed, and the patient is ventilated and extubated according to standard requirements.

4. Qualifying circumstances

CPT 32854 is performed on patients with severe lung diseases or conditions that require a lung transplant. The procedure involves the replacement of both lungs with healthy lungs from a cadaver or living donor. Cardiopulmonary bypass is used to support the patient’s hemodynamics and arterial saturation during the procedure.

5. When to use CPT code 32854

CPT code 32854 should be used when performing a double lung transplant using cardiopulmonary bypass. This code is appropriate for cases where both lungs are replaced with healthy lungs from a cadaver or living donor. It should not be used for unilateral lung transplants or procedures performed without cardiopulmonary bypass.

6. Documentation requirements

To support a claim for CPT 32854, the following documentation is required:

• Patient’s medical history and diagnosis necessitating a lung transplant
• Details of the surgical procedure, including the use of cardiopulmonary bypass
• Date and duration of the procedure
• Specific structures involved in the transplant
• Any additional procedures performed during the surgery
• Post-operative care and follow-up plans
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 32854, ensure that the procedure involves the replacement of both lungs using cardiopulmonary bypass. It is important to accurately document the details of the surgery and any additional procedures performed. CPT code 32854 should not be reported with other lung transplant codes unless multiple transplants are performed during the same procedure. It is recommended to review the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 32854 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 double lung transplant using cardiopulmonary bypass.
2. A recipient receives both lungs from a living donor in a bilateral sequential lung transplant procedure with cardiopulmonary bypass.
3. A patient with cystic fibrosis undergoes a double lung transplant with en bloc transplantation of both lungs and the heart using cardiopulmonary bypass.
4. A patient with idiopathic pulmonary fibrosis receives a double lung transplant from a cadaver donor, with revascularization of the pulmonary artery using cardiopulmonary bypass.
5. A patient with primary pulmonary hypertension undergoes a heart-lung transplant, which includes the replacement of both lungs and the heart using cardiopulmonary bypass.