How To Use CPT Code 48160

CPT 48160 describes the surgical procedure known as pancreatectomy, which involves the removal of all or part of the pancreas, followed by the autologous transplantation of pancreatic tissue or islet cells. This article will provide an overview of CPT code 48160, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 48160?

CPT 48160 is used to report the surgical procedure known as pancreatectomy, which involves the removal of either the entire pancreas or a portion of it. Following the removal, the provider harvests pancreatic tissue or islet cells and transplants them back into the patient, typically in the abdominal tissue. This procedure is commonly performed in patients with diabetes and pancreatitis, as it allows for the continued production of insulin in the body.

2. Official Description

The official description of CPT code 48160 is: ‘Pancreatectomy, total or subtotal, with autologous transplantation of pancreas or pancreatic islet cells.’ It is important to note that this code specifically refers to the transplantation of pancreatic tissue or islet cells within the same individual. If the transplantation is performed via portal vein catheterization and infusion, different codes should be used (such as 0584T, 0585T, or 0586T).

3. Procedure

1. When performing a pancreatectomy with autologous transplantation, the provider begins by making an upper midline incision in the abdomen and dissecting down to the pancreas.
2. After inspecting the upper abdomen, the provider identifies the diseased tissue and determines whether the entire pancreas needs to be removed or if a portion can be preserved.
3. The provider then identifies the pancreatic tissue or islet cells that will be harvested for reimplantation.
4. The pancreas is freed from its attachments, and the blood vessels supplying the organ are ligated.
5. Depending on the extent of the disease, the provider removes either a portion of the pancreas or the entire organ.
6. The harvested pancreatic tissue or islet cells are then transplanted into other appropriate tissue, typically in the abdomen, although other locations may be used.
7. Finally, the provider ensures hemostasis and closes the abdominal wound in layers.

4. Qualifying circumstances

CPT 48160 is typically performed in patients with diabetes and pancreatitis. It is important to note that this procedure involves the transplantation of pancreatic tissue or islet cells within the same individual, making it an autologous transplant. The provider must assess the patient’s condition and determine the need for a pancreatectomy with autologous transplantation based on their specific circumstances.

5. When to use CPT code 48160

CPT code 48160 should be used when reporting a pancreatectomy procedure that involves the removal of all or part of the pancreas, followed by the autologous transplantation of pancreatic tissue or islet cells. It is important to ensure that the transplantation is performed within the same individual. If the transplantation is performed via portal vein catheterization and infusion, different codes should be used.

6. Documentation requirements

To support a claim for CPT 48160, the provider must document the following information:

• Patient’s diagnosis and the need for a pancreatectomy with autologous transplantation
• Details of the procedure, including the extent of the pancreatectomy and the location of the transplanted tissue or islet cells
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 48160, it is important to ensure that the procedure meets the criteria outlined in the code description. The provider should report CPT 48160 for the pancreatectomy with autologous transplantation, and not for other types of pancreatic transplantation procedures. It is also important to follow any specific guidelines provided by the payer or coding guidelines for accurate billing.

8. Historical information

CPT code 48160 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been no updates or changes to the code.

9. Examples

1. A patient with chronic pancreatitis undergoes a pancreatectomy, during which a portion of the pancreas is removed and autologous transplantation of pancreatic islet cells is performed.
2. A patient with diabetes requires a total pancreatectomy due to complications, and autologous transplantation of pancreatic tissue is performed to ensure continued insulin production.
3. A provider performs a subtotal pancreatectomy with autologous transplantation of pancreatic tissue in a patient with a pancreatic tumor.
4. A patient with severe pancreatitis undergoes a total pancreatectomy, followed by autologous transplantation of pancreatic islet cells to manage their condition.
5. A provider performs a pancreatectomy with autologous transplantation of pancreatic tissue in a patient with a history of recurrent acute pancreatitis.
6. A patient with chronic pancreatitis and diabetes undergoes a total pancreatectomy, followed by autologous transplantation of pancreatic islet cells to manage both conditions.
7. A provider performs a subtotal pancreatectomy with autologous transplantation of pancreatic tissue in a patient with a pancreatic pseudocyst.
8. A patient with a pancreatic neuroendocrine tumor requires a total pancreatectomy, followed by autologous transplantation of pancreatic tissue to manage their condition.