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The procedure described by CPT® Code 44135 refers to intestinal allotransplantation from a cadaver donor. This complex surgical intervention involves the transplantation of the intestine from a deceased donor into a recipient. The process begins with the physician gaining access to the abdominal cavity, where a thorough inspection is conducted to identify any adhesions that may need to be lysed, or surgically removed. The falciform ligament, which connects the liver to the abdominal wall, is also taken down to allow for better visualization and access to the liver. The surgical incision is then extended subcostally to the right side to expose the gallbladder, which may be resected if necessary. The cecum, a part of the large intestine, is mobilized, and the mesentery, which contains blood vessels and nerves supplying the intestines, is carefully dissected from the retroperitoneal structures. Critical vascular structures, including the inferior vena cava and the superior mesenteric and renal veins, are identified and dissected to facilitate the placement of arterial and venous grafts. These grafts are then attached to the aorta and inferior vena cava, respectively, to ensure proper blood supply to the transplanted intestine. Once the donor intestine is brought into the operative field, it is anastomosed, or surgically connected, to the grafts, and perfused to ensure adequate blood flow. The recipient's native jejunum, a section of the small intestine, is resected to make way for the donor intestine, which is then anastomosed proximally and distally to complete the transplantation process. Throughout the procedure, careful attention is paid to controlling any bleeding that may occur. To support the recipient's nutritional needs post-surgery, a gastrostomy tube is placed, and the stomach is anchored to the abdominal wall. Additionally, a jejunostomy tube is inserted, and the donor intestine is exteriorized in the right lower quadrant, creating a chimney ileostomy. Finally, drains are placed as needed, and the surgical incisions are closed, with the gastrostomy and jejunostomy tubes secured with sutures. This detailed and intricate procedure is essential for patients requiring intestinal transplantation due to various medical conditions.
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The procedure of intestinal allotransplantation from a cadaver donor, as described by CPT® Code 44135, is indicated for patients who have severe intestinal failure or conditions that necessitate the replacement of the intestine. This may include patients with:
The procedure for intestinal allotransplantation involves several critical steps to ensure successful transplantation. The first step is to gain access to the abdominal cavity, where the physician inspects the area for any adhesions that may need to be lysed. This is followed by taking down the falciform ligament to allow for a better view of the liver, which is inspected for any abnormalities. The incision is then extended subcostally to the right side to expose the gallbladder, which may be resected if necessary to facilitate the procedure.
After the intestinal allotransplantation procedure, patients typically require close monitoring in a postoperative setting to assess for any complications, such as bleeding or infection. The recovery process may involve managing the patient's nutritional needs through the gastrostomy and jejunostomy tubes until the transplanted intestine begins to function adequately. Patients may also need immunosuppressive therapy to prevent organ rejection, which will be closely monitored by the healthcare team. Follow-up appointments are essential to evaluate the function of the transplanted intestine and to adjust any medications as necessary. Overall, the post-procedure care is critical for ensuring the success of the transplantation and the well-being of the patient.
| Short Descr | INTESTINE TRANSPLNT CADAVER | Medium Descr | INTESTINAL ALLOTRANSPLANTATION CADAVER DONOR | Long Descr | Intestinal allotransplantation; from cadaver donor | Status Code | Restricted Coverage | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 176 - Other organ transplantation |
| 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2011-01-01 | Changed | Short description changed. |
| 2001-01-01 | Added | First appearance in code book in 2001. |
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