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    OpenPayerBilling CodesPortal Decompression Procedures on Arteries and VeinsCPT cpt-37140-portocaval-shunt-portal-hypertension-surgery
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    CPT 37140: Portocaval Shunt Creation for Portal Hypertension

    Medicare pays $2146 on average nationally for this procedure.

    CPT code 37140 describes a surgical portocaval venous anastomosis performed via thoracoabdominal incision to create a connection between the portal vein and inferior vena cava for treatment of portal hypertension; service type: open surgical shunt creation, typical site of service: inpatient operating room or surgical suite for management of variceal bleeding risk and portal-systemic decompression.

    For related coverage guidance, see recent payer policy updates: Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure, Cardiology - Ivabradine, Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old patient with decompensated cirrhosis secondary to chronic hepatitis C presents with recurrent variceal bleeding and refractory portal hypertension despite endoscopic band ligation and medical therapy. The patient is evaluated by a multidisciplinary team including hepatology, interventional radiology, and vascular surgery. Preoperative assessment includes cross-sectional abdominal imaging, Doppler ultrasound of the portal system, laboratory evaluation (coagulation panel, liver function tests), and cardiopulmonary clearance. The patient is brought to the operating room for an open portocaval shunt procedure under general anesthesia. The surgeon performs a midline or right subcostal incision, isolates the portal vein and inferior vena cava, and constructs a portocaval venous anastomosis to decompress the portal system. Intraoperative hemodynamic monitoring and transfusion support are available. Postoperative workflow includes intensive monitoring for bleeding, hepatic encephalopathy, shunt patency assessment with Doppler ultrasound, adjustment of anticoagulation as indicated, and coordination of follow-up with hepatology for long-term management of portal hypertension and liver disease.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    37140Creation of portocaval venous shunt (anastomosis)Primary procedure for surgical decompression of portal hypertension.
    32551Tube thoracostomy, includes connection to drainage system (when performed)May be performed if thoracic exposure or pleural drainage is required during thoracoabdominal approach.
    43770Ligation, esophageal or gastric varices (endoscopic or surgical)Complementary or prior procedure for acute variceal bleeding management; may be performed before or after shunt.
    76937Ultrasound guidance for vascular access (diagnostic or therapeutic)Used intraoperatively or postoperatively for Doppler assessment of shunt patency.
    36415Collection of venous blood by venipunctureRoutine perioperative laboratory monitoring and coagulation testing.
    99100Anesthesia for procedures on patient of extreme age, under 1 or over 70 (example)Use when additional anesthesia complexity applies; specific anesthesia modifiers depend on payer rules.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    208600000X
    208800000X
    207L00000X
    1835P0018X
    2279S1500X
    261QR0400X
    1041S0200X

    Related Payer Policy Updates

    Specialty: Cardiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood PressureBluecross Idaho2026-11-01
    Cardiology - IvabradineCigna2026-10-15
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Percutaneous Ventricular Assist DeviceUnitedHealthcare2026-10-01
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Left Atrial Appendage Closure Devicesexcellus_health_plan_inc2026-09-17
    Left Atrial Appendage Closure Devicesuniverahealthcare2026-09-17
    Cardiac Omnibus CodesCigna2026-09-15

    Related Codes

    CPT-37145-RENOPORTAL-VENOUS-ANASTOMOSIS-RENAL-TO-PORTAL-VEIN

    CPT 37145: Renoportal Venous Anastomosis for Portal Flow Restoration

    CPT-37160-CAVAL-MESENTERIC-VENOUS-ANASTOMOSIS-PORTAL-HYPERTENSION

    CPT 37160: Caval–Mesenteric Venous Anastomosis

    CPT-37180-PROXIMAL-SPLENORENAL-VENOUS-ANASTOMOSIS

    CPT 37180: Proximal Splenorenal Venous Anastomosis

    CPT-37181-SPLENORENAL-SHUNT-OPEN-SURGICAL-VENOUS-BYPASS

    CPT 37181: Splenic-to-Renal (Splenorenal) Vein Shunt, Open

    CPT-37182-TIPS-SHUNT-CREATION-STENT-PLACEMENT-PORTAL-HYPERTENSION

    CPT 37182: Transjugular Intrahepatic Portosystemic Shunt (TIPS) with Stent

    CPT-37183-TIPS-SHUNT-REVISION-STENT-PLACEMENT

    CPT 37183: Transjugular Intrahepatic Portosystemic Shunt (TIPS) Revision with Stent Placement

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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