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The CPT® Code 32997 refers to a medical procedure known as total lung lavage, specifically performed on one lung (unilateral). This procedure is primarily indicated for the treatment of pulmonary alveolar proteinosis, a rare lung condition characterized by the abnormal accumulation of surfactant within the alveoli, which are the tiny air sacs in the lungs responsible for gas exchange. The buildup of surfactant can lead to significant respiratory issues, necessitating intervention. During the procedure, the physician administers oxygen to the patient prior to the lavage to enhance oxygen saturation levels, ensuring the patient is adequately oxygenated before undergoing the procedure. Following this, a general anesthetic is given, and the patient is intubated using a double lumen endotracheal tube. This specialized tube allows for one-lung ventilation, enabling the physician to perform the lavage on the affected lung while maintaining ventilation in the untreated lung. The procedure involves measuring the baseline compliance of both lungs, clamping the lung to be treated to facilitate oxygen absorption, and instilling heated normal saline into the lung. Chest percussion is utilized during the saline instillation to aid in the mobilization of the surfactant. The saline is subsequently drained, and the process of instillation and recovery is repeated several times to ensure thorough lavage. After the final cycle, a Valsalva maneuver is performed, along with aggressive bronchial suctioning, to clear any remaining surfactant. The lung compliance is then re-evaluated to confirm it has returned to baseline levels. The procedure concludes with the extubation of the patient once end-tidal CO2 and pulse oxygen saturation levels normalize.
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The total lung lavage procedure (CPT® Code 32997) is indicated for the treatment of the following condition:
The total lung lavage procedure involves several critical steps to ensure effective treatment of the affected lung.
After the total lung lavage procedure, the patient is monitored closely to ensure that their oxygen saturation levels and end-tidal CO2 return to normal. The recovery phase may involve additional respiratory support as needed, and the patient will be observed for any complications or adverse reactions. It is essential to assess lung function and compliance post-procedure to confirm the success of the lavage. The healthcare team will provide instructions for follow-up care and any necessary rehabilitation to support the patient's recovery.
| Short Descr | TOTAL LUNG LAVAGE | Medium Descr | TOTAL LUNG LAVAGE UNILATERAL | Long Descr | Total lung lavage (unilateral) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 42 - Other OR therapeutic procedures on respiratory system |
| 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2000-01-01 | Added | First appearance in code book in 2000. |
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