Summary & Overview
CPT 33935: Combined Heart and Lung Transplantation
CPT code 33935 represents a combined heart and lung transplant: the surgical removal of the patient’s heart and lung followed by implantation of a donor heart and lung. This complex, high-acuity procedure is performed in major transplant centers and carries significant clinical, logistical, and cost implications nationally due to its resource intensity and rarity. Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code covers, payer scope, and the clinical and service context for CPT code 33935. The publication summarizes typical sites of service, common modifiers used with this code (listed elsewhere), and the relevant service line for hospital billing. It also outlines benchmarks and policy-relevant considerations that affect coverage and reimbursement for high-cost organ transplantation services. Clinical context addresses the procedural nature, perioperative care needs, and inpatient hospital resource use associated with combined heart-lung transplantation. Data not available in the input is noted where specific items such as associated taxonomies, ICD-10 diagnoses, and related codes are not provided.
Billing Code Overview
CPT code 33935 describes a combined heart and lung transplantation in which the provider surgically removes the patient’s heart and lung and transplants a donor heart and lung into the patient’s body. This service is a solid-organ transplant procedure involving replacement of both cardiac and pulmonary organs in a single operative episode.
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Service type: Major surgical transplant procedure
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Typical site of service: Inpatient hospital operating room with subsequent intensive care unit and inpatient recovery
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with end-stage pulmonary and cardiac disease (advanced pulmonary hypertension with secondary right and left ventricular failure) is evaluated and listed for combined heart-lung transplantation. The patient presents with progressive dyspnea, hypoxemia on supplemental oxygen, recurrent hospitalizations for right heart failure, and refractory pulmonary vascular disease despite maximal medical therapy. Preoperative workup includes crossmatch and donor selection, infectious disease screening, cardiopulmonary testing, and multidisciplinary transplant committee approval. On the day of surgery the recipient is taken to the operating room, placed under general anesthesia, and undergoes median sternotomy. Cardiopulmonary bypass is used while the surgeon explants the native heart and lungs and implants the donor heart and bilateral lungs. Intraoperative teams include cardiothoracic surgeons, anesthesiology, perfusionists, and transplant coordinators. Postoperative care in the cardiothoracic intensive care unit focuses on hemodynamic support, ventilator management, immunosuppression initiation, infection prophylaxis, and monitoring for primary graft dysfunction. Typical site of service is an inpatient hospital operating room with subsequent ICU and transplant unit stay. Service type: Major surgical transplant procedure (combined heart and lung transplantation). Typical patient scenario: advanced combined cardiopulmonary failure meeting transplant criteria and suitable donor match; emergency modifiers may apply for intraoperative complications or donor-related factors.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |