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The CPT® Code 37140 refers to the procedure known as venous anastomosis, specifically an open portocaval anastomosis. This surgical intervention is designed to create a connection between the portal vein and the inferior vena cava, effectively diverting blood flow from the portal circulation. The procedure is commonly indicated in cases where there is increased pressure in the portal vein, often due to conditions such as portal hypertension, which can lead to serious complications like variceal bleeding. The term 'portocaval shunt' is frequently used to describe this operation, highlighting its purpose of shunting blood away from the portal system. The surgical approach involves making an extended incision below the rib cage, allowing the surgeon to access the necessary anatomical structures, including the portal vein and the inferior vena cava. The detailed steps of the procedure involve careful dissection and manipulation of these vessels to ensure a successful anastomosis, which can be performed in either an end-to-side or side-to-side configuration, depending on the specific clinical scenario and the surgeon's preference.
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The open portocaval venous anastomosis procedure (CPT® Code 37140) is indicated for several specific conditions related to portal hypertension and its complications. The following are the primary indications for performing this procedure:
The open portocaval venous anastomosis procedure involves several critical steps to ensure successful creation of the anastomosis between the portal vein and the inferior vena cava. The following outlines the procedural steps:
After the completion of the open portocaval venous anastomosis, patients typically require careful monitoring in a postoperative setting. Expected recovery may involve management of potential complications such as bleeding, infection, or thrombosis at the anastomosis site. Patients may also need to be monitored for signs of improved portal hypertension symptoms, such as reduced ascites or variceal bleeding. Follow-up care is essential to assess the patency of the anastomosis and the overall effectiveness of the procedure in managing portal hypertension.
| Short Descr | REVISION OF CIRCULATION | Medium Descr | VENOUS ANASTOMOSIS OPEN PORTOCAVAL | Long Descr | Venous anastomosis, open; portocaval | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 56 - Other vascular bypass and shunt, not heart |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | ED | Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GP | Services delivered under an outpatient physical therapy plan of care | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2003-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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