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The CPT® Code 48154 refers to a surgical procedure known as a proximal subtotal pancreatectomy with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy, specifically a pylorus-sparing, Whipple-type procedure, performed without a pancreatojejunostomy. In this complex operation, the head of the pancreas, which is the proximal portion, is surgically removed along with a significant portion of the bile duct and nearly the entire duodenum, while preserving a small segment of the duodenum, typically 3-4 cm in length. This procedure is indicated for various conditions affecting the pancreas and surrounding structures, such as tumors or chronic pancreatitis. The surgical approach involves making a subcostal or midline incision in the abdomen to access the pancreas and duodenum. The surgeon carefully mobilizes these structures, identifies critical vascular landmarks such as the superior mesenteric vein, and dissects the pancreas from its surrounding attachments. The procedure is characterized by the removal of the affected pancreatic tissue and associated structures, followed by the reconstruction of the gastrointestinal tract to maintain continuity. The absence of a pancreatojejunostomy distinguishes this procedure from similar ones, as it does not involve the anastomosis of the pancreatic duct to the jejunum. Instead, the remaining duodenum is connected to the jejunum through a gastrojejunostomy, ensuring that digestive continuity is preserved post-surgery.
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The proximal subtotal pancreatectomy with near-total duodenectomy, choledochoenterostomy, and duodenojejunostomy (CPT® Code 48154) is indicated for various medical conditions that necessitate the removal of the head of the pancreas and associated structures. These indications may include:
The procedure involves several critical steps to ensure the successful removal of the pancreatic head and reconstruction of the gastrointestinal tract. The steps include:
Post-procedure care following a proximal subtotal pancreatectomy with near-total duodenectomy involves monitoring for complications such as bleeding, infection, and pancreatic leakage. Patients may require supportive care, including pain management and nutritional support, as they recover from surgery. The placement of drains may facilitate the monitoring of any fluid accumulation. Follow-up imaging may be necessary to assess the surgical site and ensure proper healing. Patients are typically advised on dietary modifications and may need to consult with a nutritionist to manage changes in digestion and enzyme replacement therapy if necessary.
| Short Descr | PANCREATECTOMY | Medium Descr | PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY | Long Descr | Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); without 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 |
| 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). | 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. | 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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| 1994-01-01 | Added | First appearance in code book in 1994. |
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