How To Use CPT Code 48153

CPT 48153 describes a specific surgical procedure involving the removal of part of the pancreas and almost all of the duodenum. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 48153?

CPT 48153 is a code used to describe a surgical procedure that involves the removal of part of the pancreas and almost all of the duodenum. This procedure is typically performed to treat certain conditions or diseases affecting these organs, such as pancreatic cancer. It is important to note that CPT 48153 should only be used for the specific procedure described and not for other similar procedures.

2. Official Description

The official description of CPT code 48153 is: ‘Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); with pancreatojejunostomy.’

3. Procedure

1. The surgeon begins by making an upper midline incision in the abdomen and carefully dissecting down to the pancreas.
2. After inspecting the upper abdomen and identifying the area of disease, the surgeon frees the proximal pancreas from its attachments and makes an incision to remove the diseased tissue.
3. Most of the duodenum is removed during the procedure, and if present, the gallbladder may also be removed.
4. The surgeon then performs anastomosis, which involves connecting the bile ducts directly to the jejunum.
5. A new anastomosis is made between the remaining pancreas and the jejunum to drain the pancreatic enzymes.
6. An additional anastomosis is performed to connect the remaining duodenum to the jejunum.
7. Finally, the surgeon ensures hemostasis and closes the abdominal wound.

4. Qualifying circumstances

CPT 48153 is typically performed on patients who have specific conditions or diseases affecting the pancreas and duodenum, such as pancreatic cancer. The procedure is performed by a qualified surgeon and involves the removal of part of the pancreas and almost all of the duodenum. It is important to note that not all patients with pancreatic or duodenal conditions will require or qualify for this specific procedure.

5. When to use CPT code 48153

CPT code 48153 should be used when the surgeon performs the specific procedure described in the official description. It is important to accurately document the details of the procedure and ensure that it aligns with the requirements outlined in the code description. If the procedure performed does not match the description of CPT 48153, a different code should be used to accurately report the service provided.

6. Documentation requirements

When reporting CPT code 48153, the following documentation is typically required:

• Details of the patient’s condition or disease necessitating the procedure
• Specific description of the procedure performed, including the extent of the pancreas and duodenum removed
• Date of the procedure
• Any additional procedures or anastomosis performed during the surgery
• Confirmation of hemostasis and closure of the abdominal wound
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT code 48153, it is important to ensure that the procedure performed aligns with the official description. The surgeon should be qualified to perform the procedure, and the documentation should support the details of the surgery. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines. Additionally, it is important to review any updates or changes to the code to ensure accurate reporting.

8. Historical information

CPT code 48153 was added to the Current Procedural Terminology system on January 1, 1994. It has been included in the Inpatient Only (IPO) list for Medicare since 2017.

9. Examples

1. A surgeon performs CPT 48153 on a patient with pancreatic cancer, removing part of the pancreas and almost all of the duodenum.
2. During the procedure, the surgeon also performs anastomosis of the bile ducts to the jejunum and creates a new anastomosis between the remaining pancreas and the jejunum to drain pancreatic enzymes.
3. The surgeon ensures hemostasis and closes the abdominal wound after completing the procedure.
4. Another surgeon performs CPT 48153 on a patient with a complex pancreatic and duodenal condition, removing part of the pancreas and almost all of the duodenum.
5. During the procedure, the surgeon also performs anastomosis of the bile ducts to the jejunum and creates a new anastomosis between the remaining pancreas and the jejunum to restore digestive functions.
6. The surgeon ensures hemostasis and closes the abdominal wound after completing the procedure.