CPT® Code 32853

A double lung transplant, also known as bilateral lung transplant, is a surgical procedure that involves the replacement of both lungs in a single operation. This procedure can be performed using two primary techniques: bilateral sequential or en bloc. The bilateral sequential technique is the most commonly utilized method, where each lung is transplanted one at a time. The thoracic cavity is accessed through a bilateral anterolateral incision, typically made through the fourth or fifth intercostal space, allowing the surgeon to expose the lungs adequately. In certain cases, an additional incision may be necessary in the groin area to facilitate cardiopulmonary bypass if the thoracic vessels cannot be cannulated. During the procedure, the first lung is carefully excised from the recipient, and the donor lung is subsequently placed into the thoracic cavity. Various techniques may be employed for the transplant, and the order of anastomosis—connecting the bronchus, pulmonary artery, and pulmonary vein—can vary based on the surgeon's preference and the specific circumstances of the transplant. The bronchial anastomosis involves a telescoping method where the smaller bronchus is inserted into the larger bronchus and secured with sutures. This site is then covered with local tissue to promote healing and stability. Following the bronchial connection, the donor and recipient pulmonary arteries are aligned to prevent kinking and are then anastomosed. The left atrium is clamped to prepare for the connection of the pulmonary veins, where the recipient vein is incised, and a cuff is created for the anastomosis. After the lung is reinflated and air is evacuated from the pulmonary vasculature, the perfusion is restored. The surgical team evaluates the suture lines for integrity and reinforces them as necessary. Chest tubes may be placed to facilitate drainage, and the chest is subsequently closed. A flexible bronchoscopy is performed to inspect the bronchial anastomosis and ensure the airway is clear of any obstructions. The second lung is then removed from the recipient and the second donor lung is transplanted using the same meticulous technique. If the procedure is conducted without the use of cardiopulmonary bypass, it is coded as 32853, whereas if cardiopulmonary bypass is required, the appropriate code is 32854. En bloc lung transplants, which involve a different surgical approach, necessitate the use of cardiopulmonary bypass and are performed through a pleural and pericardial window.