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The procedure described by CPT® Code 47145 involves the meticulous preparation of a cadaver donor's whole liver graft prior to its transplantation into a recipient. This process is commonly referred to as backbench or back table preparation. During this procedure, the liver may be received with the gallbladder still attached; if so, a cholecystectomy, or gallbladder removal, is performed as part of the preparation. The surrounding soft tissues are carefully dissected away to expose critical vascular structures, including the vena cava, portal vein, hepatic artery, and common bile duct, which are essential for the successful implantation of the liver graft. The preparation also includes a lobe split of the whole liver graft into two partial liver grafts: the left lobe, which comprises segments II, III, and IV, and the right lobe, which includes segments I and V through VIII. This splitting of the liver allows for the potential transplantation of the graft into two separate patients, thereby maximizing the utility of the donor organ. The procedure is complex and requires a thorough understanding of liver anatomy and surgical techniques to ensure that all necessary structures are adequately prepared for transplantation, while also minimizing the risk of complications during and after the procedure.
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The backbench standard preparation of a cadaver donor whole liver graft is indicated for the following conditions:
The procedure for backbench preparation of the liver graft involves several critical steps to ensure the organ is ready for transplantation:
Post-procedure care involves monitoring the liver graft for any signs of complications, ensuring that the vascular connections are secure, and that the graft is functioning properly. The recipient will require close observation for any signs of rejection or complications related to the transplant. Additionally, the surgical team will follow specific protocols for the management of immunosuppressive therapy to prevent rejection of the graft. The recovery process will vary depending on the individual patient's condition and the complexity of the transplant procedure.
| Short Descr | PREP DONOR LIVER LOBE SPLIT | Medium Descr | BKBENCH PREPJ CADAVER DONOR WHL LVR GRF I&V VI | Long Descr | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe split of whole liver graft into 2 partial liver grafts (ie, left lobe [segments II, III, and IV] and right lobe [segments I and V through VIII]) | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | 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 | 176 - Other organ transplantation |
| 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). | 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. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 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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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| 2009-01-01 | Changed | Code description changed. |
| 2005-01-01 | Added | First appearance in code book in 2005. |
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