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The procedure described by CPT® Code 48145 refers to a distal subtotal pancreatectomy, which may or may not include the removal of the spleen (splenectomy), and involves the creation of a pancreaticojejunostomy. This surgical intervention is performed through a subcostal or midline incision in the abdomen, allowing access to the pancreas and surrounding structures. The procedure begins with the division of the gastrocolic and colosplenic ligaments, which helps in mobilizing the duodenum and the head of the pancreas. The peritoneum is then incised along the inferior border of the pancreas, facilitating blunt dissection to separate the pancreas from the posterior abdominal wall. If the spleen is to be removed, the surgical dissection extends to the hilum of the spleen, where the splenic artery is identified, divided, and ligated to ensure proper removal. The spleen, along with the distal portion of the pancreas, is retracted to expose the inferior mesenteric vein, while the splenic vein is preserved to maintain venous drainage. The mesentery of the uncinate process is also ligated and divided during this process. Once the necessary structures are freed, the body of the pancreas is incised, and a portion of the body along with the entire tail is excised. In cases where the spleen is removed, it is done concurrently with the distal pancreas. Following the resection, a pancreaticojejunostomy is performed, which involves creating a Roux-en-Y jejunal segment. This step is crucial as it establishes a connection between the head of the pancreas and the jejunum, allowing for the drainage of pancreatic secretions into the gastrointestinal tract. The procedure concludes with the closure of the pancreas using interrupted mattress sutures, flushing the wound with normal saline, placing drains, and finally closing the abdominal incision around the drains to promote healing and prevent complications.
© Copyright 2025 Coding Ahead. All rights reserved.
The distal subtotal pancreatectomy with or without splenectomy and pancreaticojejunostomy, as described by CPT® Code 48145, is indicated for various conditions affecting the pancreas. These may include:
The procedure for a distal subtotal pancreatectomy with pancreaticojejunostomy involves several critical steps, which are detailed as follows:
Post-procedure care following a distal subtotal pancreatectomy with pancreaticojejunostomy includes monitoring for complications such as bleeding, infection, and pancreatic leaks. Patients may require supportive care, including pain management and nutritional support, as they adjust to changes in pancreatic function. Follow-up imaging may be necessary to assess the surgical site and ensure proper healing. The presence of drains will be monitored, and they may be removed based on the clinical judgment of the healthcare team. Patients are typically advised on dietary modifications and may need to manage potential endocrine and exocrine insufficiencies resulting from the surgery.
| Short Descr | PARTIAL REMOVAL OF PANCREAS | Medium Descr | PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY | Long Descr | Pancreatectomy, distal subtotal, with or without splenectomy; with pancreaticojejunostomy | 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 |
This is a primary code that can be used with these additional add-on codes.
| 96547 | Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure) | 96548 | Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure) |
| 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). | 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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| Pre-1990 | Added | Code added. |
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