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Duodenal exclusion with gastrojejunostomy for pancreatic injury, as described by CPT® Code 48547, is a surgical procedure performed in response to traumatic injuries affecting the pancreas, particularly when there is involvement of the pancreatic duct and duodenum. This procedure is essential for managing complications arising from such injuries, as it aims to divert gastric contents away from the duodenum. The diversion is crucial to allow for the healing of both the duodenum and the pancreatic duct, which may be compromised due to the trauma. The surgical approach typically involves making a subcostal or midline incision in the abdomen to gain access to the affected organs. Once the pancreas and duodenum are exposed, the surgeon inspects them for any damage. A gastrotomy, or incision in the stomach, is performed to facilitate the procedure. The pylorus, which is the opening from the stomach into the duodenum, is then grasped, clamped, and sutured closed to prevent gastric contents from entering the duodenum. Subsequently, a loop gastrojejunostomy is created by dividing the jejunum, which is then anastomosed to the stomach. This surgical alteration effectively reroutes gastric flow away from the duodenum for a period ranging from several weeks to months, allowing the injured areas to heal properly. After the procedure, the abdomen is irrigated, drains are placed to manage any potential fluid accumulation, and the abdominal incision is closed around these drains. It is important to note that the exclusion suture in the pylorus is designed to eventually open, allowing the gastrojejunostomy to functionally close without the need for further surgical intervention.
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The procedure of duodenal exclusion with gastrojejunostomy for pancreatic injury is indicated in specific clinical scenarios where there is a need to manage traumatic injuries to the pancreas that also involve the pancreatic duct and duodenum. The following conditions warrant this surgical intervention:
The procedure of duodenal exclusion with gastrojejunostomy involves several critical steps to ensure effective management of the pancreatic injury. The following outlines the procedural steps:
Post-procedure care following duodenal exclusion with gastrojejunostomy involves monitoring the patient for any complications and ensuring proper recovery. The expected recovery period may vary, but it generally allows for several weeks to months for the duodenum and pancreatic duct to heal adequately. During this time, the patient may require nutritional support, as the rerouting of gastric flow can affect digestion. The drains placed during surgery will need to be monitored and managed to prevent infection or fluid accumulation. It is important to follow up with imaging or clinical assessments to ensure that the healing process is progressing as expected. The exclusion suture in the pylorus is designed to eventually open, allowing the gastrojejunostomy to functionally close without the need for further surgical intervention, which is a critical aspect of the post-operative management plan.
| Short Descr | DUODENAL EXCLUSION | Medium Descr | DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ | Long Descr | Duodenal exclusion with gastrojejunostomy for pancreatic injury | 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. | 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). | 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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| 2002-01-01 | Changed | Code description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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