How To Use CPT Code 47140

CPT 47140 refers to the surgical procedure known as donor hepatectomy, specifically the resection of the left lateral segment of the liver from a living donor. This procedure is critical in the context of liver transplantation, where a portion of the liver is removed from a healthy donor to be transplanted into a recipient in need of a liver. The left lateral segment, which includes segments II and III of the liver, is carefully excised and preserved under cold conditions until it is ready for transplantation.

1. What is CPT code 47140?

CPT code 47140 represents the surgical procedure of donor hepatectomy, which involves the removal of the left lateral segment of the liver from a living donor. This procedure is performed to facilitate liver transplantation, allowing a healthy portion of the liver to be transplanted into a recipient suffering from liver failure or other hepatic conditions. The left lateral segment consists of segments II and III of the liver, which are strategically chosen for resection due to their adequate size and functionality. The procedure is performed under general anesthesia, ensuring the donor’s safety and comfort throughout the operation. The successful execution of this procedure is vital, as it not only aids in saving the life of the recipient but also highlights the importance of living organ donation in modern medicine.

2. Qualifying Circumstances

This CPT code can be used specifically when a living donor is undergoing a hepatectomy for the purpose of organ donation. The donor must be thoroughly evaluated to ensure they are a suitable candidate for the procedure, which includes assessments of liver function, overall health, and psychological readiness. Limitations may arise if the donor has underlying liver disease or other medical conditions that could complicate the surgery. It is inappropriate to use this code if the procedure is performed on a deceased donor or if the resection involves segments other than the left lateral segment. Additionally, the procedure must be performed in a controlled surgical environment with appropriate monitoring and support.

3. When To Use CPT 47140

CPT code 47140 is utilized when a living donor is undergoing a hepatectomy specifically for the resection of the left lateral segment of the liver. This code should be used in conjunction with other relevant codes that pertain to the donor’s preoperative evaluations and postoperative care. It is important to note that this code cannot be used alongside codes that pertain to procedures involving the right lobe or other segments of the liver, as it is specifically designated for the left lateral segment. Proper documentation of the donor’s consent and the surgical procedure is essential for accurate coding and billing.

4. Official Description of CPT 47140

Official Descriptor: Donor hepatectomy (including cold preservation), from living donor; left lateral segment only (segments II and III)

5. Clinical Application

The clinical context for CPT code 47140 is centered around the need for liver transplantation, which is often necessitated by conditions such as cirrhosis, acute liver failure, or liver tumors. The procedure allows for the safe removal of a portion of the liver from a healthy living donor, which can then be transplanted into a recipient. The importance of this procedure lies in its ability to provide a viable solution for patients awaiting liver transplants, as the demand for donor organs often exceeds the supply. The successful execution of a donor hepatectomy can significantly improve the quality of life and survival rates for recipients, making it a critical component of transplant medicine.

5.1 Provider Responsibilities

The provider’s responsibilities during the donor hepatectomy include several critical steps. Initially, the provider ensures that the donor is appropriately prepped and anesthetized. The donor is positioned supine on the operating table, allowing optimal access to the abdominal cavity. An incision is made in the upper midline of the abdomen, and the provider examines the liver, palpating the left lateral segment for any signs of disease. The provider then carefully ligates and divides the left portal vein and the left portal artery to isolate the left lateral segment. Following this, the provider meticulously divides the second and third left lateral segments from their attachments, ensuring hemostasis throughout the procedure. Once the segments are resected, the provider closes the incision in layers and preserves the liver in a specially packed sealable container with a preserving solution, maintaining its viability for transplantation.

5.2 Unique Challenges

Unique challenges associated with the donor hepatectomy include the need for precise surgical technique to minimize complications such as bleeding or damage to surrounding structures. The provider must also navigate the anatomical variations that can occur in liver vasculature, which may complicate the ligation and division of blood vessels. Additionally, ensuring the donor’s safety and managing their postoperative recovery are paramount, as the procedure involves significant physiological changes. The psychological aspect of living donation also presents challenges, as providers must ensure that donors are fully informed and comfortable with their decision to donate.

5.3 Pre-Procedure Preparations

Before the procedure, the provider must conduct thorough evaluations, including imaging studies to assess liver anatomy and function, as well as laboratory tests to evaluate the donor’s overall health. A comprehensive medical history and physical examination are essential to identify any potential contraindications to surgery. Psychological evaluations may also be performed to ensure that the donor is mentally prepared for the procedure and the implications of organ donation. Proper preoperative planning is crucial to minimize risks and ensure a successful outcome.

5.4 Post-Procedure Considerations

After the donor hepatectomy, the provider must monitor the donor for any signs of complications, such as bleeding, infection, or liver dysfunction. Postoperative care includes managing pain, ensuring adequate hydration, and monitoring liver function through laboratory tests. Follow-up appointments are necessary to assess the donor’s recovery and address any concerns that may arise. The provider must also provide education and support to the donor regarding lifestyle modifications and the importance of follow-up care to ensure a smooth recovery process.

6. Relevant Terminology

Hemostasis: The process of stopping bleeding from incisions and suture lines during a surgical operation.

Hepatic portal artery: A blood vessel responsible for distributing oxygenated blood to the liver.

Hepatic portal vein: Blood vessels that drain deoxygenated blood from the liver back to the heart.

Ligate: To close, tie off, repair, or encircle a vessel or other structure with sutures or wire.

Midline: Referring to the center of the body or anatomical structure.

Supine position: A position where the patient lies flat on their back with legs extended.

7. Clinical Examples

1. A 35-year-old woman donates a portion of her liver to her brother, who is suffering from end-stage liver disease.

2. A 45-year-old man undergoes a thorough evaluation and is deemed a suitable candidate for living liver donation.

3. A donor experiences anxiety about the surgery and receives psychological support before proceeding with the hepatectomy.

4. A surgeon successfully ligates the left portal vein during the donor hepatectomy, ensuring minimal blood loss.

5. A living donor is monitored closely for signs of postoperative complications, such as infection or bleeding.

6. A donor’s liver segment is preserved in a cold solution, maintaining its viability for transplantation.

7. A healthcare team discusses the risks and benefits of living donation with a potential donor prior to surgery.

8. A donor is placed in a supine position on the operating table to facilitate access to the liver during the procedure.

9. A surgeon palpates the liver to assess the health of the left lateral segment before resection.

10. A donor receives follow-up care to monitor liver function and recovery after the hepatectomy.