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The procedure described by CPT® Code 47122 refers to a hepatectomy, specifically a trisegmentectomy, which involves the surgical resection of significant portions of the liver. In this operation, the physician removes the entire right lobe of the liver, along with the medial segment of the left lobe, and the hepatic parenchyma located to the right of the falciform ligament and the ligamentum teres. This extensive resection is also known as a right extended lobectomy. The procedure is typically performed through an incision made in the right subcostal region, which may extend into the left subcostal region or even cranially over the xiphoid process, allowing for adequate access to the liver. During the surgery, the right rectus muscle is transected, and the oblique muscles are split to facilitate access. The medial portion of the left rectus muscle is also transected to mobilize the right lobe of the liver toward the left side. Critical structures such as the cystic artery and duct are ligated and divided to prevent bleeding. The peritoneum is incised to expose the right main hepatic artery, which is carefully identified and protected throughout the procedure. The dissection continues superiorly and posteriorly, with particular attention to safeguarding the portal vein. The right main hepatic duct is then dissected free, and the hepatic vein is located and transected. The liver capsule is incised, and the parenchyma is transected, which may alternatively involve transecting the hepatic parenchyma in the interlobar plane. An incision is made to the right of the falciform ligament, allowing for access to the umbilical fissure, where vessels and ducts leading to the medial segment of the left lobe are divided, while preserving those to the lateral segment. Finally, the three segments are devascularized and excised, and the incision is closed over drains after ensuring that any bleeding is controlled and the wound is properly irrigated.
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The procedure of trisegmentectomy, as described by CPT® Code 47122, is indicated for various conditions affecting the liver. These may include:
The trisegmentectomy procedure involves several critical steps, each essential for the successful resection of the liver segments. The steps are as follows:
Post-procedure care following a trisegmentectomy involves monitoring the patient for any complications, such as bleeding or infection. Patients may require close observation in a recovery unit, and their vital signs will be closely monitored. Pain management is an essential aspect of post-operative care, and patients may be prescribed analgesics to manage discomfort. Additionally, the surgical site will need to be assessed for signs of infection or other complications. Patients are typically advised on dietary modifications and may require follow-up imaging studies to evaluate liver function and ensure that the remaining liver tissue is healthy. The expected recovery time can vary based on the individual patient's health status and the extent of the surgery performed.
| Short Descr | EXTENSIVE REMOVAL OF LIVER | Medium Descr | HEPATECTOMY RESCJ TRISEGMENTECTOMY | Long Descr | Hepatectomy, resection of liver; trisegmentectomy | 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) | 2 - Payment restriction for assistants at surgery does not apply 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 99 - Other OR gastrointestinal therapeutic procedures |
| 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| Pre-1990 | Added | Code added. |
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