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The procedure described by CPT® Code 48520 involves the internal anastomosis of a pancreatic cyst to the gastrointestinal tract, specifically for the purpose of drainage. A pancreatic cyst is a fluid-filled sac that can develop in the pancreas, and when it becomes symptomatic or poses a risk of complications, surgical intervention may be necessary. The internal anastomosis allows for the cyst to be directly connected to the gastrointestinal tract, facilitating the drainage of its contents. This procedure can be performed through either bilateral subcostal incisions or a midline abdominal incision, depending on the surgeon's preference and the specific anatomy of the patient. During the operation, the cyst is carefully exposed, and fluid is aspirated to confirm that it is indeed a fluid-filled cyst. This aspiration also provides an opportunity to assess the thickness of the cyst wall, which is crucial for determining the appropriate management. A biopsy of the cyst wall is performed to rule out any potential malignancy, ensuring that the cyst is benign before proceeding with the anastomosis. The anastomosis itself is typically made to the posterior wall of the stomach, a procedure known as cystogastrostomy, or to the duodenum, referred to as cystoduodenostomy. This surgical intervention aims to alleviate symptoms and prevent further complications associated with pancreatic cysts.
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The procedure described by CPT® Code 48520 is indicated for patients with symptomatic pancreatic cysts that require drainage. The following conditions may warrant this surgical intervention:
The procedure for CPT® Code 48520 involves several critical steps to ensure successful anastomosis of the pancreatic cyst to the gastrointestinal tract. The following procedural steps are performed:
Post-procedure care following the internal anastomosis of a pancreatic cyst involves monitoring the patient for any signs of complications, such as infection or leakage from the anastomosis site. Patients may require hospitalization for observation and management of any postoperative symptoms. Pain management is typically provided, and the surgical site is monitored for proper healing. Follow-up imaging studies may be necessary to assess the success of the anastomosis and ensure that the cyst is adequately drained. Patients are usually advised on dietary modifications and activity restrictions during the recovery period to promote healing and prevent complications.
| Short Descr | FUSE PANCREAS CYST AND BOWEL | Medium Descr | INT ANAST PANCREATIC CYST GI TRACT DIRECT | Long Descr | Internal anastomosis of pancreatic cyst to gastrointestinal tract; direct | 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 |
| 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). | 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. | 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. | 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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