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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.

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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.

Service type: Open surgical vascular shunt procedure for portal hypertension
Typical site of service: Inpatient operating room with post‑operative inpatient care

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CPT 37140: Portocaval Shunt for Portal Hypertension

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Billing Code Overview

Service type: Open surgical vascular shunt procedure for portal hypertension
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.
`11`	Professional Component	Use when billing only the professional component of a service (rare for this surgical procedure).
`22`	Increased Procedural Services	Use when work required to perform the procedure is substantially greater than typically required.
`23`	Unusual Anesthesia	Use when general anesthesia is contraindicated and unusual circumstances require anesthesia not typically used.
`26`	Professional Component	Use if only the professional interpretation component is billed (e.g., imaging read separate from facility).
`50`	Bilateral Procedure	Use when bilateral anatomical procedures are performed (typically not applicable to this unilateral abdominal procedure).
`51`	Multiple Procedures	Use when this procedure is billed on the same day as other distinct surgical procedures.
`52`	Reduced Services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued Procedure	Use when the procedure is terminated due to extenuating circumstances after anesthesia induction.
`62`	Two Surgeons	Use when two surgeons of different specialties work together as primary surgeons.
`78`	Return to OR for Related Procedure by Same Physician	Use for a return to the operating room for a related procedure during the postoperative period.
`80`	Assistant Surgeon	Use when an assistant surgeon is required and assists during the procedure.
`81`	Minimum Assistant Surgeon	Use when a minimal assistant surgeon assists.
`82`	Assistant Surgeon (When Qualified Resident Not Available)	Use when an assistant surgeon is required but a qualified resident is not available.

Taxonomy Code	Specialty	Notes
208000000X	General Surgery	General surgeons perform open portal decompression and vascular anastomoses.
208600000X	Vascular Surgery	Vascular surgeons perform complex venous anastomoses and shunt construction.
208800000X	Thoracic Surgery	Thoracic surgeons may be involved when thoracoabdominal exposure is required.
207Z00000X	Transplant Surgery	Transplant/hepatobiliary surgeons may perform portocaval shunts in complex liver disease cases.
207L00000X	Interventional Radiology	Interventional radiologists perform alternative transjugular intrahepatic portosystemic shunts (TIPS) and collaborate in perioperative care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K76.6`	Portal hypertension	Primary indication for creation of a portocaval shunt to decompress the portal venous system.
`I85.01`	Esophageal varices with bleeding	Indicates active or prior variceal hemorrhage that may prompt definitive shunt therapy.
`I85.11`	Gastric varices with bleeding	Gastric variceal bleeding may require portal decompression with a surgical shunt.
`K74.60`	Unspecified cirrhosis of liver	Underlying liver disease commonly causing portal hypertension and need for shunting.
`K72.90`	Hepatic failure, unspecified without coma	Advanced liver dysfunction increasing complexity of surgical management; relevant to perioperative risk.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37140`	Creation of portocaval venous shunt (anastomosis)	Primary procedure for surgical decompression of portal hypertension.
`32551`	Tube thoracostomy, includes connection to drainage system (when performed)	May be performed if thoracic exposure or pleural drainage is required during thoracoabdominal approach.
`43770`	Ligation, esophageal or gastric varices (endoscopic or surgical)	Complementary or prior procedure for acute variceal bleeding management; may be performed before or after shunt.
`76937`	Ultrasound guidance for vascular access (diagnostic or therapeutic)	Used intraoperatively or postoperatively for Doppler assessment of shunt patency.
`36415`	Collection of venous blood by venipuncture	Routine perioperative laboratory monitoring and coagulation testing.
`99100`	Anesthesia 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.

CPT 37145: Renoportal Venous Anastomosis, Renal-to-Portal Vein

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

CPT 37160: Caval–Mesenteric Venous Anastomosis for Portal Hypertension

CPT-37180-PROXIMAL-SPLENORENAL-VENOUS-ANASTOMOSIS

CPT 37180: Proximal Splenorenal Venous Anastomosis

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

CPT 37181: Splenorenal Shunt, Open Surgical Venous Bypass

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

CPT 37182: TIPS Creation with Stent for Portal Hypertension

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

CPT 37183: TIPS Shunt Revision with Stent Placement

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier; standard reporting	Use for routine reporting when no special modifier applies.
`11`	Professional Component	Use when billing only the professional component of a service (rare for this surgical procedure).
`22`	Increased Procedural Services	Use when work required to perform the procedure is substantially greater than typically required.
`23`	Unusual Anesthesia	Use when general anesthesia is contraindicated and unusual circumstances require anesthesia not typically used.
`26`	Professional Component	Use if only the professional interpretation component is billed (e.g., imaging read separate from facility).
`50`	Bilateral Procedure	Use when bilateral anatomical procedures are performed (typically not applicable to this unilateral abdominal procedure).
`51`	Multiple Procedures	Use when this procedure is billed on the same day as other distinct surgical procedures.
`52`	Reduced Services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued Procedure	Use when the procedure is terminated due to extenuating circumstances after anesthesia induction.
`62`	Two Surgeons	Use when two surgeons of different specialties work together as primary surgeons.
`78`	Return to OR for Related Procedure by Same Physician	Use for a return to the operating room for a related procedure during the postoperative period.
`80`	Assistant Surgeon	Use when an assistant surgeon is required and assists during the procedure.
`81`	Minimum Assistant Surgeon	Use when a minimal assistant surgeon assists.
`82`	Assistant Surgeon (When Qualified Resident Not Available)	Use when an assistant surgeon is required but a qualified resident is not available.

Taxonomy Code	Specialty	Notes
208000000X	General Surgery	General surgeons perform open portal decompression and vascular anastomoses.
208600000X	Vascular Surgery	Vascular surgeons perform complex venous anastomoses and shunt construction.
208800000X	Thoracic Surgery	Thoracic surgeons may be involved when thoracoabdominal exposure is required.
207Z00000X	Transplant Surgery	Transplant/hepatobiliary surgeons may perform portocaval shunts in complex liver disease cases.
207L00000X	Interventional Radiology	Interventional radiologists perform alternative transjugular intrahepatic portosystemic shunts (TIPS) and collaborate in perioperative care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K76.6`	Portal hypertension	Primary indication for creation of a portocaval shunt to decompress the portal venous system.
`I85.01`	Esophageal varices with bleeding	Indicates active or prior variceal hemorrhage that may prompt definitive shunt therapy.
`I85.11`	Gastric varices with bleeding	Gastric variceal bleeding may require portal decompression with a surgical shunt.
`K74.60`	Unspecified cirrhosis of liver	Underlying liver disease commonly causing portal hypertension and need for shunting.
`K72.90`	Hepatic failure, unspecified without coma	Advanced liver dysfunction increasing complexity of surgical management; relevant to perioperative risk.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37140`	Creation of portocaval venous shunt (anastomosis)	Primary procedure for surgical decompression of portal hypertension.
`32551`	Tube thoracostomy, includes connection to drainage system (when performed)	May be performed if thoracic exposure or pleural drainage is required during thoracoabdominal approach.
`43770`	Ligation, esophageal or gastric varices (endoscopic or surgical)	Complementary or prior procedure for acute variceal bleeding management; may be performed before or after shunt.
`76937`	Ultrasound guidance for vascular access (diagnostic or therapeutic)	Used intraoperatively or postoperatively for Doppler assessment of shunt patency.
`36415`	Collection of venous blood by venipuncture	Routine perioperative laboratory monitoring and coagulation testing.
`99100`	Anesthesia 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.

CPT 37145: Renoportal Venous Anastomosis, Renal-to-Portal Vein

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

CPT 37160: Caval–Mesenteric Venous Anastomosis for Portal Hypertension

CPT-37180-PROXIMAL-SPLENORENAL-VENOUS-ANASTOMOSIS

CPT 37180: Proximal Splenorenal Venous Anastomosis

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

CPT 37181: Splenorenal Shunt, Open Surgical Venous Bypass

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

CPT 37182: TIPS Creation with Stent for Portal Hypertension

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

CPT 37183: TIPS Shunt Revision with Stent Placement

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 37140: Portocaval Shunt for Portal Hypertension

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Billing Code Overview

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CPT 37140: Portocaval Shunt for Portal Hypertension

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References