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The procedure described by CPT® Code 48148 involves the excision of the ampulla of Vater, a critical anatomical structure located at the junction of the bile duct and the pancreatic duct within the second part of the duodenum. This surgical intervention, commonly referred to as an ampullectomy, is performed to address various conditions affecting the ampulla, such as tumors or obstructions. The procedure typically requires a subcostal or midline incision in the abdomen to provide access to the duodenum. Once the incision is made, the surgeon mobilizes the second part of the duodenum to facilitate the excision. The use of stay sutures in the duodenal wall helps stabilize the area during the operation. A catheter is then utilized to cannulate the bile and pancreatic ducts, allowing for precise manipulation and resection. The duodenal mucosa surrounding the ampulla of Vater is carefully resected, followed by the transection of the biliary and pancreatic ducts. The excision of the ampulla is performed with attention to the surrounding structures to minimize complications. After the ampulla is removed, the biliary and pancreatic ducts are reconstructed by approximating their common walls and suturing them to the duodenal wall. This reconstruction is critical for restoring normal drainage into the duodenum, and the ducts are probed with biliary dilators to ensure they are of adequate size. Finally, the duodenum is closed, and the surgical wound is irrigated with normal saline. In some cases, drains may be placed to facilitate postoperative drainage, and the abdomen is subsequently closed around these drains to complete the procedure.
© Copyright 2025 Coding Ahead. All rights reserved.
The excision of the ampulla of Vater, as described by CPT® Code 48148, is indicated for various clinical conditions that may affect the ampulla and surrounding structures. These indications include:
The procedure for excising the ampulla of Vater involves several critical steps, each designed to ensure the safe and effective removal of the ampulla while preserving surrounding structures. The steps include:
After the excision of the ampulla of Vater, patients typically require careful monitoring and management to ensure proper recovery. Post-procedure care may include pain management, monitoring for signs of infection, and ensuring that the drainage from the surgical site is adequate. Patients may also need to follow specific dietary guidelines as they recover, particularly if there are changes in digestive function due to the surgery. Follow-up appointments are essential to assess healing and the functionality of the reconstructed ducts, ensuring that there are no complications such as strictures or leaks. Overall, the recovery process will vary based on individual patient factors and the complexity of the procedure.
| Short Descr | REMOVAL OF PANCREATIC DUCT | Medium Descr | EXCISION AMPULLA VATER | Long Descr | Excision of ampulla of Vater | 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 |
| 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. | 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). | 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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| Pre-1990 | Added | Code added. |
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