2025 CPT code 48100
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Open biopsy of the pancreas using any method (e.g., fine needle aspiration, needle core biopsy, wedge biopsy).
Modifiers may apply depending on the circumstances of the procedure.Consult the CPT manual and payer guidelines for specific modifier usage.
Medical necessity for an open pancreatic biopsy is established when imaging studies reveal a suspicious mass or lesion in the pancreas, and a tissue diagnosis is required for definitive diagnosis or treatment planning (e.g., before surgery, chemotherapy, or radiation therapy).The procedure may also be medically necessary to evaluate the extent of pancreatic inflammation in patients with chronic pancreatitis.
The surgeon is responsible for performing the open surgical procedure, including making the incision, identifying the lesion, obtaining the tissue sample, achieving hemostasis, and closing the incision.A pathologist is responsible for examining the tissue sample and providing a diagnosis.
In simple words: The doctor makes an incision in your abdomen to reach your pancreas. They then take a small sample of tissue from the pancreas to check for diseases or problems under a microscope.
This CPT code 48100 represents an open surgical biopsy of the pancreas.The procedure involves a surgical incision in the upper abdomen to access the pancreas. The surgeon identifies the target lesion and obtains a tissue sample using a suitable method, such as wedge biopsy, fine needle aspiration (FNA), or core needle biopsy.Hemostasis is achieved, and the incision is closed in layers. The tissue sample is then sent for pathological examination to determine the diagnosis.
Example 1: A 55-year-old male patient presents with persistent abdominal pain and elevated pancreatic enzymes. Imaging studies reveal a suspicious mass in the pancreas. An open biopsy is performed to obtain a tissue sample for diagnostic evaluation., A 60-year-old female patient undergoes a Whipple procedure (pancreaticoduodenectomy) for suspected pancreatic cancer. During the surgery, an open biopsy is taken from a suspicious area of the pancreas to confirm the diagnosis., A 70-year-old patient with a history of chronic pancreatitis presents with worsening symptoms. An open biopsy is performed to assess the extent of the inflammation and rule out malignancy.
* Preoperative diagnostic imaging (e.g., CT scan, MRI, ultrasound) showing the location of the pancreatic lesion.* Operative report detailing the surgical approach, type of biopsy performed, and amount of tissue obtained.* Pathology report with microscopic examination and diagnosis.* Anesthesia record.* Consent form.
** The choice of biopsy method (wedge, FNA, core needle) depends on the size and location of the lesion, as well as the surgeon's preference. The code encompasses various approaches, but the documentation must clearly specify the technique used.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Specialties:Surgical Oncology, Gastroenterology, Hepatobiliary Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center