Go Unlisted for Frey’s Procedure Coding
Question: What is the correct way to report Frey’s procedure? Florida Subscriber Answer: The key to coding Frey’s procedure lies in understanding what the surgery entails. According to an article published in the March 1, 2016, edition of the Journal of Clinical and Diagnostic Research, it consists of a “local pancreatic head resection combined with longitudinal pancreatico-jejunostomy.” The description tells you that the surgery is comprised of two parts. Knowing this, you may be tempted to use 48145 (Pancreatectomy, distal subtotal, with or without splenectomy; with pancreaticojejunostomy). However, this would be incorrect, as the type of pancreaticojejunostomy performed in a Frey’s procedure does not involve excising the pancreas, which is what 48145 reports, but a resection and draining of the pancreas. Further, the pancreatectomy described in 48145 is distal, meaning the furthest part of the pancreas anatomically speaking; whereas Frey’s procedure is performed on the head, or the closest, proximal part of the pancreas. Consequently, as none of the other pancreatectomy codes suitably describe the procedure, and as 48548 (Pancreaticojejunostomy, side-to-side anastomosis (Puestow-type operation)) does not describe the resection of the pancreatic head that is central to the Frey’s procedure, you will have to use an unlisted code, such as 48999 (Unlisted procedure, pancreas). When billing, you can use 48153 (Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); with pancreatojejunostomy) as an equivalent work-value procedure. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
