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A distal near-total pancreatectomy, also known as a Child-type procedure, involves the surgical removal of the majority of the pancreas while preserving the duodenum. This procedure is characterized by the excision of approximately 95% of the pancreas, specifically targeting the body and tail, while ensuring that the duodenum remains intact. The operation typically begins with a subcostal or midline incision in the abdomen, allowing access to the abdominal cavity. During the procedure, the gastrocolic and colosplenic ligaments are divided to facilitate the mobilization of the duodenum and the head of the pancreas. The surgical team carefully incises the peritoneum along the inferior border of the pancreas to perform blunt dissection, which helps free the pancreas from the posterior abdominal wall. The spleen is also dissected free and retracted to provide visibility of the inferior mesenteric vein. The procedure requires meticulous attention to the preservation of blood vessels that supply the duodenum, ensuring that the patient maintains adequate blood flow post-surgery. The pancreatic duct is identified, and drainage to the duodenum is confirmed before the pancreas is sutured closed. Finally, the surgical site is flushed with normal saline, drains are placed, and the abdomen is closed around these drains to promote healing and prevent complications.
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The distal near-total pancreatectomy is indicated for various conditions affecting the pancreas, particularly when significant portions of the pancreas need to be removed while preserving the duodenum. The following are specific indications for this procedure:
The distal near-total pancreatectomy involves several critical procedural steps to ensure the successful removal of the pancreas while preserving surrounding structures. The following outlines the detailed steps of the procedure:
After the distal near-total pancreatectomy, patients typically require careful monitoring and management to ensure a smooth recovery. Post-procedure care may include pain management, monitoring for signs of infection, and ensuring proper drainage from the surgical site. Patients may also need to be assessed for any complications related to pancreatic function, such as diabetes or digestive issues, due to the significant reduction in pancreatic tissue. Follow-up appointments are essential to evaluate recovery progress and manage any long-term effects of the surgery.
| Short Descr | PANCREATECTOMY | Medium Descr | PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX | Long Descr | Pancreatectomy, distal, near-total with preservation of duodenum (Child-type procedure) | 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 |
| AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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