© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 47125 refers to a total left lobectomy, which is a surgical operation involving the complete resection of the left lobe of the liver. This procedure is typically indicated for various hepatic conditions, including tumors, cirrhosis, or other liver diseases that necessitate the removal of the left lobe to prevent further complications or to treat existing pathologies. The surgery is performed through an incision that is strategically made in the right subcostal region, which may extend into the left subcostal area or even cranially over the xiphoid process, allowing adequate access to the liver. During the operation, the surgeon transects the right rectus muscle and splits the oblique muscles to gain entry to the abdominal cavity. The medial portion of the left rectus muscle is also transected to facilitate the procedure. The ligaments associated with the left lobe are severed, enabling mobilization of the lobe for resection. The surgical team carefully dissects the inferior vena cava and the hepatic veins located above the liver, ensuring that all necessary vascular structures are addressed. The left hepatic artery is divided, and the left branch of the portal vein is identified and ligated to prevent blood flow to the lobe being removed. The left lobe is then retracted to the right side, and the lesser omentum is transected to further expose the area. The ligamentum venosum is identified and divided, followed by the ligation of the middle and left hepatic veins. To facilitate the resection, vessels supplying the right liver are temporarily occluded with clamps. The liver is divided by marking the transection line with electrocautery, followed by the division of the parenchyma using scissors and blunt clamp dissection. After the left lobe is excised, the vascular and biliary structures are ligated to ensure hemostasis and prevent bile leaks. The blood supply to the right lobe is restored, and the surgical team examines the raw surface of the right lobe for any signs of bleeding or bile leaks, addressing any issues through coagulation or suture ligation. Finally, the wound is irrigated, drains are placed as necessary, and the incision is meticulously closed with sutures to promote healing.
© Copyright 2025 Coding Ahead. All rights reserved.
The total left lobectomy, as described by CPT® Code 47125, is indicated for several specific conditions affecting the liver. These may include:
The procedure for a total left lobectomy involves several critical steps to ensure successful resection of the left lobe of the liver. The process begins with the surgeon making an incision in the right subcostal region, which may extend into the left subcostal area or cranially over the xiphoid process to provide adequate access to the liver. Following the incision, the right rectus muscle is transected, and the oblique muscles are split to facilitate entry into the abdominal cavity. The medial portion of the left rectus muscle is also transected to further enhance access.
Once the abdominal cavity is accessed, the ligaments associated with the left lobe of the liver are severed, allowing for mobilization of the lobe. The inferior vena cava and the hepatic veins located above the liver are carefully dissected to ensure that all vascular structures are properly managed during the procedure. The left hepatic artery is then divided, and the left branch of the portal vein is identified and ligated to prevent blood flow to the lobe being resected.
With the vascular structures addressed, the left lobe is retracted to the right side, and the lesser omentum is transected to provide further exposure. The ligamentum venosum is identified and divided near its attachment to the left hepatic vein. Subsequently, the middle and left hepatic veins are located and ligated to secure the area. To facilitate the resection, vessels supplying the right liver are temporarily occluded with clamps, which helps to minimize blood loss during the procedure.
The actual division of the liver is performed by first marking the line of transection with electrocautery, which helps to delineate the area for resection. The parenchyma is then divided using scissors and blunt clamp dissection techniques. Once the left lobe is completely removed, the vascular and biliary structures are ligated to ensure hemostasis and prevent any potential bile leaks. After the left lobe is excised, the blood supply to the right lobe is restored, and the raw surface of the right lobe is examined for any signs of bleeding or bile leaks. Any bleeding is controlled through coagulation, and biliary leaks are addressed with clipping and suture ligation.
Finally, the surgical site is irrigated to clear any debris, drains are placed as needed to manage fluid accumulation, and the incision is meticulously closed with sutures to promote optimal healing.
Post-procedure care following a total left lobectomy involves monitoring the patient for any complications such as bleeding, infection, or bile leaks. Patients are typically observed in a recovery area before being transferred to a hospital room for further monitoring. Pain management is an essential aspect of post-operative care, and patients may receive analgesics as needed. The surgical site is regularly assessed for signs of infection or abnormal drainage from any placed drains. Patients are encouraged to gradually resume normal activities as tolerated, with specific instructions provided regarding diet, activity level, and follow-up appointments. The healthcare team will also monitor liver function tests to ensure that the remaining liver tissue is functioning adequately following the resection.
| Short Descr | PARTIAL REMOVAL OF LIVER | Medium Descr | HEPATECTOMY RESCJ TOTAL LEFT LOBECTOMY | Long Descr | Hepatectomy, resection of liver; total left lobectomy | 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). | 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). | 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. | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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) |
|
Date
|
Action
|
Notes
|
|---|---|---|
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.