2025 CPT code 48520

Direct internal anastomosis of a pancreatic cyst to the gastrointestinal tract.

Refer to the official CPT manual for comprehensive coding guidelines. The choice between 48520 and 48540 depends on the surgical technique utilized.Accurate documentation is paramount for appropriate code selection.

Modifiers may apply depending on the circumstances of the procedure.Consult the CPT manual and payer guidelines for specific modifier usage. Common modifiers include those for multiple procedures (51), increased procedural services (22), or assistant surgeon (80).

Medical necessity is established by the presence of a symptomatic pancreatic cyst causing pain, obstruction, or risk of rupture.Conservative management may be tried prior to surgical intervention depending on clinical presentation.Documentation of symptoms and response to conservative measures should be included.

The surgeon is responsible for the preoperative assessment, intraoperative procedure (including incision, cyst identification, drainage, anastomosis, irrigation, and closure), and postoperative care. Anesthesiologist provides anesthesia, and other medical staff may assist.

IMPORTANT 48540 (Internal anastomosis of pancreatic cyst to gastrointestinal tract; Roux-en-Y) is used when the Roux-en-Y technique is employed.

In simple words: The doctor creates an opening between a fluid-filled sac (cyst) on the pancreas and the small intestine, allowing the cyst's contents to drain internally. This relieves pain and stops problems such as internal bleeding.

This procedure involves creating a surgical connection between a pancreatic cyst and the gastrointestinal tract (usually the small intestine) to internally drain the cyst's contents.This is done to alleviate pain from an enlarging cyst and prevent complications like internal bleeding from cyst rupture. The surgeon makes an incision, accesses the cyst, removes its contents, creates an opening in the small intestine, and then sutures the cyst wall to the intestinal wall to allow continuous drainage. The surgical site is then irrigated, hemostasis is ensured, instruments are removed, and the incision is closed.

Example 1: A 55-year-old male presents with persistent abdominal pain and a large pancreatic cyst identified on imaging.A direct internal drainage is performed to alleviate the pain and prevent potential rupture. , A 60-year-old female with a history of pancreatitis presents with an asymptomatic pancreatic pseudocyst that is causing compression of adjacent organs.Internal drainage is performed to alleviate the compression., A 40-year-old male presents with acute pancreatitis and develops a symptomatic pseudocyst.After conservative management fails, direct internal drainage is performed.

Complete medical history, physical examination findings, imaging studies (CT scan, MRI) demonstrating the pancreatic cyst, operative report detailing the procedure, and pathology report (if applicable) are essential.

** Always refer to the most current CPT and payer guidelines for accurate coding and reimbursement.

  • Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
  • RVU: Information not available.RVUs vary based on geographic location and other factors. Consult your local payer for specific information.
  • Global Days : Information not available in provided text.The global surgical period will vary depending on payer and local practice guidelines.
  • Payment Status: Active
  • Modifier TC rule: Information not provided. The applicability of a Technical Component (TC) modifier is dependent on payer guidelines.
  • Fee Schedule : Fee schedules are not provided. This information can be found in the CMS fee schedule.
  • Specialties:General Surgery, Gastroenterology, Hepatobiliary Surgery
  • Place of Service:Inpatient Hospital, Ambulatory Surgical Center
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