If you are being seen for lung volume reduction surgery (LVRS) at Duke, please bring the following information with you to your first clinic visit (if not already submitted to us):

• Completed "Patient Information Form" (to be sent to you by the surgeon's office)
• Report (physician or clinic notes) of your last visit with your primary pulmonary specialist, including physical exam and results of any blood work performed
• Pertinent related pulmonary testing results, such as pulmonary function tests or cardiac stress test, performed within the past nine months
• Any chest x-rays and chest computed tomography (CT scan) performed within the past nine months (actual films, not just the written reports of interpretation)
• Records of any pulmonary rehabilitation in which you have been participating

During the first clinic visit, you will have the following:

• Pulmonary function testing
• Chest x-ray and high-resolution chest CT scan
• Blood work
• Appointment with thoracic surgeon
• Appointment with pulmonologist (if it is determined that you need to see a Duke Pulmonary Medicine specialist)

Based on information we obtain during interviews, it may be determined that further testing is required. Not everyone will require all of these tests.

Other tests that may be scheduled as needed, including:

• Electrocrdiogram (ECG or EKG): All patients must have a current ECG prior to surgery. This test involves a set of adhesive pads placed on the chest and then connected to a machine that reads the electrical activity of your heart.
• Ventilation-perfusion scan: In this test performed in the nuclear radiology department, you are given a small amount of radioactive dye through your vein and also asked to breathe in a medication that is able to be seen on a specialized scanner. This allows us to see both the flow of blood to and in your lungs, as well as see where the air goes in your lungs.
• Echocardiogram: This is a non-invasive test performed in the Cardiac Diagnostic Unit which uses high-frequency ultrasound waves to visualize structures in the heart and thus help doctors determine how well the heart is pumping, how well the heart valves are working and helps estimate the pressures within your heart chambers.
• Right Heart Catheterization: If it is suspected that you have a condition called "pulmonary hypertension" (increased blood pressure of the blood supply to the lungs), we may schedule for a heart catheterization. This is a diagnostic test in which a thin tube called a catheter is inserted into a vein in the leg and passed to the heart. Contrast solution (or dye) is injected through the catheter and an x-ray camera takes pictures of the blood flow and allows direct measurement of the pressures in the heart chambers.

Insurance

This procedure is approved for coverage by Medicare, with eligibility requirements that one must meet before the surgery will be performed.

These requirements included specific tests and parameters of results, as well as the requirement for some formal pulmonary rehabilitation before and after the surgery. Questions about these requirements and tests can be addressed to the Duke LVRS coordinator at 919-668-2402. Some private insurers may also cover the procedure. You should contact your local Medicare office and your private insurance carrier and ask the following questions:

• Is Lung Volume Reduction Surgery a covered benefit in your policy? They may ask for the ICD9 code for the procedure -- 32.22 -- to check.
• Are tests and consultations done in preparation for potential surgery a covered benefit? Are they covered even if they don’t cover the actual surgery?
• Is there a deductible that you will have to pay for the tests and/or surgery?
• What percent of the bill will you be responsible to pay out of pocket?

If your policy does not cover the LVRS, you still have options:

• You can seek out another insurance carrier. Of course, before changing carriers you need to find out if they cover the surgery for a current or previously diagnosed illness.
• We will consider performing the surgery if you elect to self-pay. There is a considerable deposit required by the hospital and you should fully understand the risk of financial burden. We will review this major decision with you and will help in any way that we can.