Summary & Overview
CPT 37140: Portocaval Shunt for Portal Hypertension
CPT code 37140 represents an open surgical portocaval shunt (portocaval venous anastomosis) used to treat portal hypertension by diverting portal venous flow to the inferior vena cava and lowering pressure in gastroesophageal varices. The procedure is clinically important as a definitive surgical option to prevent life‑threatening gastrointestinal bleeding when endovascular or endoscopic measures are insufficient or contraindicated. Nationally, this code is relevant for tertiary care hospitals, transplant centers, and vascular surgery programs that manage advanced portal hypertension cases.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, an explanation of typical sites of service, and an outline of what to expect in payer coverage considerations. The publication summarizes benchmarks and utilization patterns where available, highlights pertinent coding and billing considerations, and reviews policy and reimbursement themes affecting access to surgical shunt procedures. This summary is intended to inform hospital administrators, coding professionals, and clinical program leads about the role and coding of CPT code 37140 in national practice.
Billing Code Overview
CPT code 37140 describes a surgical portocaval shunt (portocaval venous anastomosis) performed through an incision of the thoracic and abdominal region to create a connection between the portal vein and the inferior vena cava. The procedure is a surgical treatment for portal hypertension, often employed when portal vein narrowing or obstruction causes high venous pressure that risks variceal bleeding in the stomach and esophagus.
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Service type: Open surgical vascular shunt procedure for portal hypertension
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Typical site of service: Inpatient operating room with post‑operative inpatient care
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use for routine reporting when no special modifier applies. |