Summary & Overview
CPT 37145: Renoportal Venous Anastomosis, Renal-to-Portal Vein
CPT code 37145 defines an open surgical procedure to create a renoportal venous anastomosis — a direct connection between the renal vein and the portal vein — most often used to restore portal inflow to a transplanted liver graft when the native portal vein is stenosed or occluded. Nationally, this code represents a high-acuity, hospital-based operative intervention typically carried out by transplant or vascular surgeons and carries implications for coverage, inpatient billing, and specialized perioperative care.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, common billing modifiers and coding considerations, and what to expect in terms of payer coverage themes and documentation priorities. The publication also summarizes related billing and policy issues that affect reimbursement and authorization for high-complexity transplant-related vascular procedures. This resource is intended to inform coding staff, billing managers, and clinical leaders about the procedural definition, site-of-service expectations, and areas where payer policies and documentation frequently influence claim outcomes. Data not available in the input for specific payer rates, ICD-10 pairings, and associated taxonomies is noted where relevant.
Billing Code Overview
CPT code 37145 describes a surgical procedure in which a provider makes an abdominal incision and creates a renoportal venous anastomosis, connecting the renal vein of a kidney to the portal vein of the liver. The procedure is most commonly performed to restore portal flow to an implanted liver graft when the portal vein is stenosed or occluded.
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Service type: Open surgical vascular anastomosis involving abdominal organs for restoration of portal circulation.
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Typical site of service: Inpatient operating room in a hospital setting, typically performed by transplant or vascular surgery teams.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with a living-donor liver transplant presents with progressive portal vein stenosis and decreasing portal flow to the graft, manifesting as rising liver enzymes, portal hypertension signs, and graft dysfunction. Imaging (Doppler ultrasound, CT angiography) confirms a high-grade portal vein stenosis with inadequate portal inflow. The transplant surgery team schedules an open surgical revision under general anesthesia. In the operating room the provider performs a midline laparotomy, identifies the stenotic portal vein, mobilizes the transplanted kidney or a native renal vein graft as indicated, and constructs a renoportal venous anastomosis between the renal vein and the portal vein to restore portal flow to the liver graft. Intraoperative portal flow is assessed with Doppler or direct flow measurement. Hemostasis is achieved, abdominal closure completed, and the patient is transferred to the intensive care unit for postoperative monitoring of graft function, portal flow, and anticoagulation management as indicated. Typical documentation includes indication (portal vein stenosis/occlusion), operative details of the anastomosis, vessels used, intraoperative flow assessment, complications if any, and postoperative plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default — No modifier | No modifier required; use when no special reporting applies |