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The procedure described by CPT® Code 47147 involves the backbench reconstruction of a liver graft, which can be sourced from either a cadaver or a living donor, prior to its transplantation into a recipient. This intricate process is essential for ensuring that the liver graft is adequately prepared to function effectively once transplanted. During this procedure, any anatomical variations in the arterial or venous blood supply to the donor liver are meticulously identified and reconstructed. This is performed in a controlled environment, often referred to as a back table procedure, where the graft is examined in detail. The hepatic venous drainage system is inspected thoroughly, and any anomalies in the blood vessels are corrected through reconstruction and anastomosis, which involves surgically connecting blood vessels to restore proper blood flow. The common hepatic artery, which is one of the three branches of the celiac artery, is typically responsible for supplying blood to the liver. However, it is important to note that the liver may also receive blood supply from the other two branches of the celiac artery, namely the splenic and gastric arteries, or even from the superior mesenteric artery. These alternative arterial sources are preserved during the procedure and are revascularized by connecting them to the main hepatic circulation, ensuring that the liver graft receives adequate blood supply post-transplantation. This procedure is critical for the success of the liver transplant, as it directly impacts the viability and functionality of the graft once it is implanted into the recipient.
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The backbench reconstruction of a liver graft, as described by CPT® Code 47147, is indicated in several scenarios where anatomical variations in the blood supply to the liver are present. These indications include:
The procedure for backbench reconstruction of a liver graft involves several critical steps, each aimed at ensuring the graft is properly prepared for transplantation. The steps include:
After the backbench reconstruction procedure is completed, the liver graft is carefully prepared for transplantation. Post-procedure care involves monitoring the graft to ensure that the arterial and venous connections are secure and functioning properly. The surgical team will assess the graft's blood flow and may perform imaging studies to confirm that the reconstruction has been successful. Additionally, the recipient will be prepared for the transplant surgery, and the graft will be transported to the operating room under sterile conditions. Close attention is paid to the graft's viability, as any complications during this phase could impact the success of the transplantation.
| Short Descr | PREP DONOR LIVER/ARTERIAL | Medium Descr | BKBENCH RCNSTJ LVR GRF ARTL ANAST EA | Long Descr | Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis, each | Status Code | Active 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). | 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. | 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. | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2005-01-01 | Added | First appearance in code book in 2005. |
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