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Thread: CPT for Laparoscopic distal pancreatectomy

  1. #1
    Join Date
    Apr 2007
    Lexington, Kentucky

    Default CPT for Laparoscopic distal pancreatectomy

    AAPC: Back to School
    Please help. Need CPT for Laparoscopic spleen preserving distal pancreatectomy. I'm thinking unlisted 48999? Why..Why..isn't there a code for this?

    OPERATIVE PROCEDURE: After informed consent was reviewed she was taken
    back to the Operating Room. She was placed in a supine position.
    Sequential compression devices and perioperative antibiotics were
    administered, followed by a general endotracheal anesthetic. She was then
    placed in the low lithotomy position and prepped and draped in the usual
    sterile fashion. Local anesthesia was infiltrated in the subcutaneous
    tissues beneath her umbilicus. A linear incision was created extending
    into the umbilicus using a #11 blade. Blunt dissection was used to carry
    down to the level of the abdominal fascia. The fascia was incised in the
    midline using a #11 blade, and a figure-of-eight 0 Vicryl suture placed
    there. A Hasson trocar was inserted. Pneumoperitoneum was achieved using
    standard CO2 insufflation techniques. I then placed the patient in steep
    reverse Trendelenburg position. Under direct endoscopic surveillance I
    placed additional trocars in standard positioning for laparoscopic
    pancreatic surgery.

    The operation began by dividing the gastrocolic ligament and entering the
    lesser sac by dividing this below the gastroepiploic vessels. This
    division was continued along the length of the greater curvature of the
    stomach, widely exposing the pancreatic tail. A Nathanson liver retractor
    was inserted for anterior retraction of the stomach. We began the
    operation by incising the peritoneum on the inferior aspect of the
    pancreas. Carefully this was continued distally, and we then developed a
    plane in the retropancreatic space using an EnSeal device to seal any
    encountered retroperitoneal small vessels. Once an adequate space was
    created we then divided the peritoneum overlying the cephalad surface of
    the pancreas and began developing this space in an attempt to join the 2
    spaces. The splenic artery was encountered initially, and this was
    carefully dissected distally, freeing up a sizable segment of the splenic
    artery. We then encountered the splenic vein and circumferentially
    mobilized it as well. It was approached best from the posterior surface of
    the pancreas. Once the pancreas was able to be retracted well anteriorly,
    we began our more thorough retropancreatic dissection continuing distally.
    We inserted a laparoscopic ultrasound probe, and we were able to identify
    the position of the cyst. We developed a plane proximally in the pancreas
    to accommodate a laparoscopic GIA stapling device. We divided the pancreas
    at the distal body just proximal to the position of the cyst seen on
    ultrasound. A vascular cartridge was used as well as seam guard, and I was
    able to insert a 2-0 Prolene stitch at the inferior border of the pancreas
    to control its marginal vessel. The staple line was completely hemostatic.
    We then carefully undertook the dissection of the splenic vein which was
    densely adherent to the pancreas gland at its anterior border. Judicious
    use of the electrocautery was used as well as blunt traction, counter
    traction, carefully mobilizing the splenic vein inferiorly. Some bleeding
    was encountered at one point that was controlled with a 3-0 Prolene stitch.
    Very happy with hemostasis at this point, we continued this dissection
    distally. Blood loss at this point was about 175 mL. We were able to
    completely mobilize the pancreas gland away from the splenic vein and
    divided it with the EnSeal device just beyond its distal portion. Again
    great care was taken to avoid injury to the splenic vessels, and we ensured
    a complete resection of the distal pancreas. It was placed in an EndoCatch
    bag and delivered through the periumbilical trocar site. It was sent to
    Pathology for examination. The frozen section analysis determined it to be
    a benign lesion, and at this point we reviewed the abdomen for additional
    bleeding. The operative field appeared to be hemostatic. I did use
    Tisseel over the proximal pancreatic staple line and in the area of
    dissection of the splenic vessels. A drain was placed just beside the
    pancreatic staple line, and this was exteriorized to the far lateral trocar
    site. Trocars and the Nathanson liver retractor were removed under direct
    endoscopic surveillance. The fascia at the umbilicus was closed using the
    previously 0 Vicryl suture and an additional 0 Vicryl figure-of-eight
    stitch. Skin incisions were closed with Monocryl suture and topical skin

    The patient tolerated the procedure very well. She was transported back to
    the Recovery Room in suitable condition.

    This operation took approximately 5 hours and required the use of two
    general surgeons as well as advanced laparoscopic expertise.
    Sharon Greene, CPC

  2. #2
    Join Date
    Apr 2007
    Vancouver Washington


    One of my docs does this same procedure, and we will out 48999, with the equivilant open being 48140. We rarely have issues getting reimbursed, however it always requires us to drop the op note to the insurance company. Good Luck!!
    Jaime Wicklund, CPC

  3. #3
    Join Date
    Apr 2007
    Lexington, Kentucky

    Thumbs up

    Thanks so much
    Sharon Greene, CPC

  4. #4



    I hvae a request for a laparoscopic partial pancreatectomy, splenectomy and I can't seem to find a specific code. usually, I use the laparoscopic unlisted code but the only code listed is unlisted procedure pancreas which is an open code. please help!

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