How To Use CPT Code 48154

CPT 48154 describes a specific surgical procedure involving the removal of part of the pancreas and almost the entire duodenum. 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 48154?

CPT 48154 is a code used to describe a surgical procedure that involves the removal of part of the pancreas and almost the entire duodenum. This procedure is known as a proximal subtotal pancreatectomy with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy. It is important to note that this procedure does not include the connection of the jejunum to a pancreatic duct, cyst, or fistula.

2. Official Description

The official description of CPT code 48154 is: ‘Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); without pancreatojejunostomy.’

3. Procedure

1. During the procedure, the surgeon makes an upper midline incision in the abdomen and dissects 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, and if present, the gallbladder may also be removed.
4. The surgeon then performs anastomosis, connecting the bile ducts directly to the jejunum.
5. Anastomosis of the remaining duodenum to the jejunum is also performed.
6. Finally, the surgeon ensures hemostasis and closes the abdominal wound.

4. Qualifying circumstances

CPT 48154 is typically performed on patients who require the removal of part of the pancreas and almost the entire duodenum. This procedure is commonly used to treat conditions such as pancreatic cancer. It is important to note that this procedure does not involve the removal of any part of the stomach. The specific qualifying circumstances for CPT 48154 should be determined by the surgeon based on the patient’s condition and medical history.

5. When to use CPT code 48154

CPT code 48154 should be used when a surgeon performs a proximal subtotal pancreatectomy with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy without pancreatojejunostomy. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 48154, the surgeon must document the following information:

• Patient’s diagnosis and the need for the surgical procedure
• Specific details of the procedure performed, including the removal of part of the pancreas and almost the entire duodenum
• Date of the procedure
• Any additional procedures performed, such as the removal of the gallbladder
• Details of the anastomosis performed, including the connection of the bile ducts to the jejunum and the duodenum to the jejunum
• Confirmation of hemostasis and closure of the abdominal wound
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT 48154, it is important to ensure that the documentation supports the specific details of the procedure performed. This code should not be reported with other codes that involve the removal of part of the stomach or pancreatojejunostomy. It is recommended to review the specific billing guidelines provided by the payer to ensure accurate reporting and reimbursement.

8. Historical information

CPT code 48154 was added to the Current Procedural Terminology system on January 1, 1994. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement.

9. Examples

1. A patient with pancreatic cancer undergoes a proximal subtotal pancreatectomy with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy.
2. A surgeon performs a proximal subtotal pancreatectomy with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy on a patient with a complex pancreatic disease.
3. During a surgical procedure, a surgeon removes part of the pancreas and almost the entire duodenum, performing anastomosis to restore digestive functions.
4. A patient with a rare pancreatic disorder undergoes a proximal subtotal pancreatectomy with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy.