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The procedure described by CPT® Code 48153 involves a complex surgical operation known as a proximal subtotal pancreatectomy with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy, commonly referred to as a pylorus-sparing Whipple-type procedure. This surgery entails the removal of the head, or proximal portion, of the pancreas, which is a vital organ involved in digestion and blood sugar regulation. Along with the pancreas, a significant portion of the duodenum, which is the first part of the small intestine, is excised, preserving only a small segment of 3-4 cm of the duodenum. Additionally, the procedure may include a pancreatojejunostomy, where the pancreas is surgically connected to the jejunum, the second part of the small intestine, to facilitate digestive processes. The surgical approach typically involves making a subcostal or midline incision in the abdomen to access the pancreas and surrounding structures. During the operation, the surgeon mobilizes the duodenum and the head of the pancreas, identifies critical vascular structures such as the superior mesenteric vein, and carefully dissects the pancreas from its attachments to the surrounding mesenteric vessels. The procedure is intricate, requiring precise dissection and anastomosis (surgical connection) of the pancreas and jejunum, as well as the bile duct to the jejunum, ensuring that the digestive system can function properly post-surgery. The careful removal of these structures and the subsequent reconnections are essential for the patient's recovery and long-term health outcomes.
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The proximal subtotal pancreatectomy with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy is indicated for various conditions affecting the pancreas and surrounding structures. The following are explicitly provided indications for this procedure:
The surgical procedure for CPT® Code 48153 involves several critical steps, each essential for the successful execution of the operation:
After the completion of the procedure, patients typically require careful monitoring and management in a postoperative setting. Expected recovery may involve a hospital stay for several days, during which the surgical site is observed for any signs of complications such as infection or bleeding. Patients may be placed on a modified diet initially, gradually progressing to a regular diet as tolerated. Pain management is also an important aspect of post-operative care. Additionally, follow-up appointments will be necessary to monitor the patient's recovery and to assess the function of the pancreas and digestive system following the surgery. Any specific instructions regarding activity restrictions, medication management, and dietary modifications will be provided by the healthcare team to ensure optimal recovery.
| Short Descr | PANCREATECTOMY | Medium Descr | PNCRTECT W/PANCREATOJEJUNOSTOMY | Long Descr | Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); with pancreatojejunostomy | 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 | 73 - Ileostomy and other enterostomy |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | CR | Catastrophe/disaster related | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 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. | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, 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 | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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