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The procedure described by CPT® Code 47136 refers to liver allotransplantation, specifically a heterotopic transplantation, which can involve either a partial or whole liver from a cadaver or living donor, regardless of the donor's age. In this surgical procedure, the liver is accessed through a bilateral subcostal incision that may extend into the upper midline, allowing the surgeon to expose the liver adequately. Unlike orthotopic transplantation, where the diseased liver is removed, in heterotopic transplantation, the diseased liver remains in place. Instead, the donor liver is positioned in an ectopic site, which is as close to the recipient's liver as possible. This technique involves intricate surgical steps, including the anastomosis of the vascular structures of the donor liver to the recipient's blood vessels, ensuring proper blood flow. The arterial and portal venous inflow is sourced from the infrarenal aorta and the superior mesenteric vein, while the venous outflow from the donor liver is directed into the recipient's infrarenal inferior vena cava. Additionally, the donor bile duct is connected to either the recipient bile duct or the jejunum, and a T-tube is placed in the bile duct for external drainage. Post-surgery, drains may be inserted into the abdomen as necessary, and the abdominal incision is subsequently closed. This procedure is complex and requires careful planning and execution to ensure successful transplantation and recovery.
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The indications for performing a heterotopic liver allotransplantation (CPT® Code 47136) include various conditions that may necessitate the transplantation of liver tissue. These indications can encompass:
The procedure for heterotopic liver allotransplantation involves several critical steps, which are outlined as follows:
After the heterotopic liver allotransplantation procedure, patients typically require close monitoring in a postoperative setting. Expected recovery may involve managing potential complications such as bleeding, infection, or bile leaks. The placement of drains will facilitate the removal of excess fluid and help prevent complications. Patients will also need to be monitored for signs of organ rejection and may require immunosuppressive therapy to prevent the body from rejecting the transplanted liver. Follow-up care is essential to assess liver function and overall health, ensuring that the transplanted liver is functioning effectively and that the patient is recovering well.
| Short Descr | TRANSPLANTATION OF LIVER | Medium Descr | LVR ALTRNSPLJ HTRTPC PRTL/WHL DON ANY AGE | Long Descr | Liver allotransplantation; heterotopic, partial or whole, from cadaver or living donor, any age | Status Code | Restricted Coverage | 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) | 2 - Team surgeons permitted; pay by report. | 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 | Not applicable/unspecified. | CCS Clinical Classification | 176 - Other organ transplantation |
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| 2016-01-01 | Deleted | Code deleted, to report see 47399 |
| 1995-01-01 | Added | First appearance in code book in 1995. |
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