2025 CPT code 48153
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Excision Procedures on the Pancreas Surgery Feed
This code represents a pylorus-sparing Whipple procedure, a surgical technique involving the removal of a subtotal portion of the proximal pancreas and a near-total duodenectomy, along with a choledochoenterostomy and duodenojejunostomy, and includes pancreatojejunostomy.
Modifiers 22 (Increased Procedural Services), 51 (Multiple Procedures), 52 (Reduced Services), 53 (Discontinued Procedure), 59 (Distinct Procedural Service), 62 (Two Surgeons), may be applicable depending on the specifics of the procedure and the circumstances under which it was performed.Appropriate modifier use should be supported by the operative note.
The medical necessity for a pylorus-sparing Whipple procedure (48153) is typically established by the presence of a specific diagnosis (e.g., pancreatic cancer, chronic pancreatitis, or a large pancreatic cyst), with the surgery deemed necessary to address symptoms, prevent complications, and improve the patient's quality of life.The extent of the disease and patient's overall health also influence this decision. Payer-specific guidelines should be consulted.
The surgical team, including the surgeon, anesthesiologist, and possibly other support staff, are responsible for the care of the patient during and after the procedure.The surgeon's responsibilities include proper pre-operative assessment, the performance of the surgery, and appropriate post-operative care.
In simple words: This surgery removes part of the pancreas and most of the duodenum (part of the small intestine).The surgeon reconnects the bile duct, duodenum, and pancreas to the remaining intestine to restore digestion.
CPT code 48153, Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); with pancreatojejunostomy, describes a complex surgical procedure.It involves the resection of a substantial portion of the proximal pancreas, while preserving the pylorus. A near-total duodenectomy is performed, along with the creation of a new connection between the common bile duct and the jejunum (choledochoenterostomy), and a reconnection of the remaining duodenum to the jejunum (duodenojejunostomy).Crucially, the procedure also includes pancreatojejunostomy, the surgical creation of an anastomosis between the remaining pancreatic duct and the jejunum to ensure proper drainage of pancreatic enzymes. This pylorus-sparing approach aims to preserve gastric emptying function.
Example 1: A 60-year-old male patient presents with a diagnosis of pancreatic cancer localized to the head of the pancreas.A pylorus-sparing Whipple procedure (48153) is performed, including the resection of the proximal pancreas, near-total duodenectomy, choledochoenterostomy, duodenojejunostomy, and pancreatojejunostomy., A 55-year-old female patient is diagnosed with chronic pancreatitis causing significant pain and dysfunction.Due to the location and extent of inflammation, a pylorus-sparing Whipple procedure (48153) is performed to resect the affected portion of the pancreas and duodenum, restoring digestive function., A 70-year-old male presents with a pancreatic cyst requiring extensive surgical intervention.A pylorus-sparing Whipple procedure (48153) is performed to resect the cyst and surrounding tissue, along with the reconstruction steps included in this code.
Detailed operative notes describing the extent of the resection (proximal pancreas and near-total duodenectomy), the specifics of the anastomoses created (choledochoenterostomy, duodenojejunostomy, and pancreatojejunostomy), and any complications or variations from the standard procedure.Pre-operative imaging, pathology reports, and post-operative progress notes are also essential.Documentation should clearly support medical necessity.
** Accurate code selection is critical for appropriate reimbursement.Thorough documentation of the procedure is essential for supporting the selection of CPT code 48153.Always verify the procedure details in the operative report and other documentation before assigning a code.
- Revenue Code: P1G - MAJOR PROCEDURE - OTHER
- RVU: The RVUs for CPT code 48153 vary based on geographic location, facility type, and other factors.Consult a relevant fee schedule for precise values.
- Global Days: The global period for this procedure is typically 90 days, encompassing the pre-operative, operative, and post-operative care.However, this can vary based on payer policies and individual circumstances.
- Payment Status: Active
- Modifier TC rule: No TC modifier applicable.
- Fee Schedule: Historical fee schedules are not available here; consult a specific payer's historical data or a medical billing resource.
- Specialties:Surgical Oncology, Gastroenterology, Hepatobiliary Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center