Heart Transplant procedure codes

Cdafonzo

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I am new to heart transplant. Does anyone have a list of the regular procedure codes that go along with transplantation? Thanks
 

cpc2007

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The codes for the transplant and any associated services will be dependent on the documentation in each case. Generally speaking, though, the main codes I typically report for a heart transplant include the insertion of the transplanted heart itself (33945). Of note, this code also includes a native cardiectomy (removal of the patient's heart in preparation for transplant). Also it is quite common to report backbench prep (33944) where the surgeon placing the heart into the recipient patient spends some time preparing the donor heart to fit the recipient patient (the back bench typically involves work such as removing excess tissue from the aorta, the superior vena cava, the inferior vena cava, and/or the left atrium to allow the donor heart to fit appropriately).

Other codes I often pick up in heart transplant can include removal of an intracorporeal ventricular assist device - also known as a VAD (33980). A VAD is a device that takes over function of the failing heart while the patient waits for transplant. With these devices, the surgeon would be removing a pump from within the patient's body along with cannulas (tubes that allow blood to flow in and out of the VAD) and a driveline (a power cord that connects the pump in the patient's body to a console on the outside of the body that provides power to the device). I also often code for removal of an implantable cardiac defibrillator (ICD) which is often placed in patients with heart failure to shock the heart and help it resume function while the patient waits for transplant. With an ICD, you will have a battery/generator as well as leads. CPT 33241 would be removal of the generator while 33243/33244 would be coded for removal of leads. Your exact code would depend on whether the leads were removed through the open sternotomy/thoracotomy incision for transplant (which would take you to 33243) or if they were removed through a transvenous approach where a guidewire and/or laser tool are inserted through a vein and used to free up and extract the leads (which would take you to 33244). Of note, sometimes the leads are epicardial (attached to the heart surface) so they come out "en bloc" with the patient's native heart (meaning the leads are left attached to the surface of the heart and since the heart is being removed the leads are naturally removed with it in one maneuver). When this happens, do not code any additional CPT codes for ICD lead removal as it is just a natural part of the native cardiectomy which is already credited to the surgeon with CPT 33945.

Finally, you may also have a second surgical team responsible for harvesting the heart from the donor. If you code for the team harvesting the donor heart, you would code 33940 if the heart alone is harvested or 33930 if that same team harvests the heart and lungs together en bloc (or as one specimen). You would need a separate operative report from the second surgical team harvesting the donor organs before assigning these codes as the same surgeon typically never harvests the donor organs and implants the transplanted organs into the recipient patient because the work happens simultaneously to reduce the time the recipient is on bypass and ensure preservation of the donor organs.

Again your exact codes will depend on the documentation for each case, but these are the most common things I see when coding heart transplant. I hope that helps :)- have a great night.

Kim
www.codingmastery.com
 
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