CPT® Code 48400

1. Indications

The injection procedure for intraoperative pancreatography, represented by CPT® Code 48400, is indicated in specific clinical scenarios where visualization of the pancreatic ducts is necessary. This may include situations where there is a suspicion of pancreatic duct injury or obstruction during a surgical procedure. The following conditions may warrant the use of this code:

• Pancreatic Duct Injury The procedure is indicated when there is a concern for potential damage to the pancreatic duct during surgical interventions, allowing for immediate assessment and management.
• Obstruction of the Pancreatic Duct In cases where there is a suspected blockage in the pancreatic duct, this procedure aids in visualizing the ductal anatomy to determine the extent and nature of the obstruction.

2. Procedure

The injection procedure for intraoperative pancreatography involves several critical steps to ensure accurate visualization of the pancreatic ducts. The following procedural steps outline the process:

• Step 1: Identification of the Distal Pancreatic Duct During the surgical procedure, the surgeon identifies the distal pancreatic duct, which is essential for the subsequent steps of the injection process. This identification is crucial for ensuring that the contrast agent is accurately delivered to the correct anatomical location.
• Step 2: Catheter Insertion Once the distal pancreatic duct is located, a catheter is carefully inserted into the duct. This step requires precision to avoid any potential damage to the surrounding tissues and to ensure that the catheter is properly positioned for the injection of the contrast agent.
• Step 3: Injection of Contrast Agent After the catheter is in place, a contrast agent is injected in a retrograde fashion. This means that the dye is introduced against the natural flow of pancreatic secretions, allowing for optimal visualization of the ductal system. The injection of the contrast agent is a critical step, as it enables the surgeon to visualize the pancreatic ducts on imaging studies.
• Step 4: Visualization and Evaluation Following the injection, the pancreatic ducts are visualized and evaluated for any signs of injury or obstruction. This evaluation is essential for determining the appropriate course of action, whether it involves further surgical intervention or monitoring.

3. Post-Procedure

After the injection procedure for intraoperative pancreatography is completed, the patient may require specific post-procedure care. This includes monitoring for any potential complications related to the injection, such as pancreatitis or infection. The surgical team will assess the patient's recovery and may perform follow-up imaging studies to evaluate the effectiveness of the procedure and to ensure that the pancreatic ducts are functioning properly. Additionally, the results of the pancreatography will guide further management decisions regarding the patient's condition.