How To Use CPT Code 48120

CPT 48120 describes the excision of a lesion in the pancreas, such as a cyst or adenoma. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 48120?

CPT 48120 is used to describe the surgical removal of a lesion in the pancreas. This code is specifically used for excisions of lesions such as cysts or adenomas. The procedure involves making an incision in the upper midline of the abdomen, inspecting the pancreas and surrounding tissue, identifying the lesion, and using various surgical tools to remove it. The abdominal wound is then closed in layers.

2. Official Description

The official description of CPT code 48120 is: ‘Excision of lesion of pancreas (eg, cyst, adenoma).’ This code falls under the range of excision procedures on the pancreas, specifically within the range of 48100-48160.

3. Procedure

1. After the patient is properly prepped and anesthetized, the healthcare provider makes an incision in the upper midline of the abdomen.
2. They carefully inspect the pancreas and peripancreatic tissue to identify the specific lesion, which could be a cyst or adenoma.
3. Using surgical tools such as a scalpel, stapler, or electrocautery, the provider removes the lesion from the pancreas.
4. Once the lesion is successfully excised, the provider closes the abdominal wound in layers to promote proper healing.

4. Qualifying circumstances

CPT 48120 is used when there is a need to remove a lesion in the pancreas, such as a cyst or adenoma. The patient must have a documented diagnosis of the specific lesion, and the excision must be performed by a qualified healthcare provider. It is important to note that this code is specific to the excision of lesions in the pancreas and should not be used for other procedures or conditions.

5. When to use CPT code 48120

CPT code 48120 should be used when a healthcare provider performs an excision of a lesion in the pancreas, such as a cyst or adenoma. It is important to ensure that the procedure performed aligns with the official description of the code. If the excision is for a different type of lesion or in a different anatomical location, a different CPT code should be used.

6. Documentation requirements

When reporting CPT code 48120, the healthcare provider must document the following information:

• The patient’s diagnosis of the specific lesion in the pancreas
• A detailed description of the procedure performed, including the specific tools used
• The date of the procedure
• Any complications or additional procedures performed during the same session
• The provider’s signature to authenticate the documentation

7. Billing guidelines

When billing for CPT code 48120, it is important to ensure that the excision of the lesion in the pancreas meets the criteria outlined in the official description. This code should not be reported with other codes unless there are documented circumstances that justify the additional codes. It is crucial to review the specific billing guidelines provided by the payer to ensure accurate and appropriate reimbursement.

8. Historical information

CPT code 48120 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates or changes since its addition. However, it is important to stay updated with any changes or revisions to the code in future editions of the CPT manual.

9. Examples

1. A surgeon performs an excision of a pancreatic cyst using CPT code 48120.
2. A gastroenterologist removes an adenoma from the pancreas using CPT code 48120.
3. A patient undergoes an open excision of a benign tumor in the pancreas, and CPT code 48100 is reported.
4. A surgeon performs an excision of a malignant tumor in the pancreas, and CPT code 48102 is reported.
5. A patient undergoes an open excision of a pseudocyst in the pancreas, and CPT code 48110 is reported.