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The CPT® Code 48554 refers to the transplantation of a pancreatic allograft, which is a surgical procedure where a donor pancreas is implanted into a recipient. This procedure is critical for patients with severe diabetes or pancreatic dysfunction, as it can restore insulin production and improve metabolic control. There are two primary surgical techniques utilized during pancreas transplantation. The first technique involves placing the pancreas in the lower abdomen, where the digestive enzymes produced by the pancreas are directed to drain into the urinary bladder. The second technique involves placing the pancreas in the abdomen and creating an anastomosis, which is a surgical connection, between the attached segment of the duodenum (the first part of the small intestine) and the jejunum (the second part of the small intestine). This allows the digestive enzymes to drain directly into the intestine, facilitating normal digestive processes. Additionally, pancreas transplantation is often performed concurrently with kidney transplantation, particularly in patients with diabetes-related kidney failure. The surgical approach for the recipient typically involves a midline intraperitoneal incision, which provides access to the abdominal cavity. If a kidney transplant is part of the procedure, it is performed first, followed by the pancreas transplant. The surgical technique includes careful vascular connections to ensure proper blood flow to the transplanted pancreas, which is essential for its function. The procedure also involves securing the pancreas to the abdominal wall to allow for future biopsies, if necessary, and managing postoperative care with the placement of drains and a nasogastric tube to aid recovery.
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The transplantation of a pancreatic allograft is indicated for patients suffering from severe diabetes, particularly those with type 1 diabetes, who may also have associated complications such as kidney failure. The procedure is aimed at restoring insulin production and improving glycemic control, thereby reducing the risk of diabetes-related complications. Additionally, pancreas transplantation is often indicated for patients who are candidates for concurrent kidney transplantation due to diabetic nephropathy.
The procedure for pancreas transplantation involves several critical steps to ensure successful implantation and function of the allograft. Initially, if a kidney transplant is also being performed, the kidney transplant is conducted first. Following this, the pancreas is prepared for transplantation. The surgical team begins by making a midline intraperitoneal incision to access the abdominal cavity. The donor pancreas is then positioned in the lower abdomen. To facilitate the drainage of digestive enzymes, the portal vein of the donor pancreas is anastomosed end-to-side to a major tributary of the recipient's superior mesenteric vein. This connection is crucial for ensuring adequate blood supply to the transplanted pancreas. Next, the donor iliac artery is brought through a window in the distal mesentery and anastomosed end-to-side to the right common iliac artery of the recipient, establishing the necessary arterial supply. For the drainage of digestive enzymes into the intestine, the segment of duodenum attached to the donor pancreas is anastomosed to a diverting Roux-en-Y in the recipient jejunum. This step is essential for normal digestive function post-transplant. Once the pancreas is revascularized, the tail of the pancreas is anchored to the anterior abdominal wall using interrupted sutures. This anchoring is important as it allows for subsequent allograft biopsy using a percutaneous ultrasound-guided technique, should it be necessary. After the pancreas is securely placed and all vascular connections are established, a nasogastric tube is inserted to assist with postoperative care. Additionally, drains may be placed in the abdomen as needed to manage any excess fluid or potential complications. Finally, the surgical wound is closed, completing the procedure.
Post-procedure care following pancreas transplantation involves monitoring the patient for any signs of complications, such as infection or rejection of the allograft. The placement of a nasogastric tube aids in managing gastrointestinal function during the initial recovery phase. Patients will typically require close monitoring of their blood glucose levels, as adjustments in insulin therapy may be necessary following the transplant. Additionally, the surgical team may perform routine follow-up biopsies of the pancreas to assess for any signs of rejection or complications. The recovery period will vary based on individual patient factors, but comprehensive postoperative care is essential to ensure the success of the transplant and the overall health of the patient.
| Short Descr | TRANSPL ALLOGRAFT PANCREAS | Medium Descr | TRANSPLANTATION PANCREATIC ALLOGRAFT | Long Descr | Transplantation of pancreatic allograft | Status Code | Restricted Coverage | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 2 - Team surgeons permitted; pay by report. | 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 | 176 - Other organ transplantation |
| 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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). | 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). | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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