How To Use CPT Code 38101

CPT 38101 describes a specific surgical procedure known as partial splenectomy. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 38101?

CPT 38101 is a code used to describe a surgical procedure called partial splenectomy. This procedure involves the removal of a specific part of the spleen. It is typically performed for patients who have experienced a traumatic rupture of the spleen, hemolytic anemia, or cancer of the spleen.

2. Official Description

The official description of CPT code 38101 is: ‘Splenectomy; partial (separate procedure).’ This code specifically refers to the partial removal of the spleen as a separate procedure.

3. Procedure

1. During a partial splenectomy, the provider makes an incision into the abdominal cavity, typically below the left ribs.
2. The spleen is exposed and carefully released from the surrounding structures.
3. The arteries and veins supplying the targeted part of the spleen are ligated and divided.
4. The ligaments holding the specific segment of the spleen are incised, allowing for the removal of that portion of the spleen.
5. The surgical site is irrigated, and a drain may be placed if necessary.
6. The provider ensures bleeding is controlled and closes the wound in layers with sutures.

4. Qualifying circumstances

CPT 38101 is performed for patients who have a traumatic rupture of the spleen, hemolytic anemia, or cancer of the spleen. It is important to note that this code should not be reported if any other major procedure is performed in the same location and session.

5. When to use CPT code 38101

CPT code 38101 should be used when a partial splenectomy is performed as a separate procedure. It is important to ensure that no other major procedures are performed in the same location and session to accurately report this code.

6. Documentation requirements

To support a claim for CPT 38101, the provider must document the following information:

• Patient’s diagnosis indicating the need for a partial splenectomy
• Details of the procedure, including the incision site and approach
• Specific part of the spleen removed
• Any additional procedures performed during the same session
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 38101, it is important to ensure that the procedure is performed as a separate procedure and no other major procedures are performed in the same location and session. It is also crucial to follow any specific guidelines provided by insurance companies or payers.

8. Historical information

CPT code 38101 was added to the Current Procedural Terminology system on January 1, 1990. The only notable update to this code was its inclusion under the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A patient with a traumatic rupture of the spleen undergoes a partial splenectomy to remove the damaged portion of the organ.
2. A patient diagnosed with hemolytic anemia requires a partial splenectomy to address the abnormal destruction of red blood cells.
3. A patient with cancer of the spleen undergoes a partial splenectomy as part of their treatment plan.
4. A provider performs a partial splenectomy as a separate procedure, without any other major procedures performed in the same session.
5. A patient with a traumatic rupture of the spleen undergoes a partial splenectomy, and a drain is placed to monitor post-operative bleeding.
6. A provider performs a partial splenectomy using a laparoscopic approach for a patient with trauma-related spleen injury.
7. A patient with hemolytic anemia undergoes a partial splenectomy, and the provider documents the specific part of the spleen removed.
8. A provider performs a partial splenectomy for a patient with cancer of the spleen, ensuring accurate documentation of the procedure details.
9. A patient undergoes a partial splenectomy as a separate procedure, with no complications or unexpected findings reported.
10. A provider performs a partial splenectomy for a patient, ensuring proper documentation and adherence to billing guidelines.