Not the final chapter: The national emphysema treatment trial

In 1995, Medicare faced a dilemma. Shortly following the publication of the first contemporary case series of lung volume reduction surgery (LVRS) by Cooper et al. (1), there was a remarkable increase in the number of lung resections being performed in patients with chronic obstructive pulmonary disease (COPD) (2). Outcome and cost data for these operations were not readily available, because the absence of a specific Medicare billing code made it impossible to distinguish resections for cancer or lung nodules from those for LVRS. Nevertheless, the expense of a major thoracic resection, coupled with the high prevalence of emphysema, threatened to produce a Medicare cost estimated as high as $47 billion (3). In October 1995, the Health Care Financing Administration (HCFA; now the Centers for Medicare and Medicaid Services, CMS) published an International Classification of Disease code for LVRS. This facilitated tracking of the procedure, although the extent to which other codes continued to be used for this operation remained uncertain.