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    v1.0.30
    OpenPayerBilling CodesPortal Decompression Procedures on Arteries and VeinsCPT cpt-37145-renoportal-venous-anastomosis-renal-to-portal-vein
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    CPT 37145: Renoportal Venous Anastomosis for Portal Flow Restoration

    Medicare pays $1994 on average nationally for this procedure.

    CPT code 37145 describes a surgical procedure in which the abdomen is opened and a renoportal venous anastomosis is created to connect the renal vein to the portal vein, typically performed to restore portal flow for an implanted liver graft with a stenosed or occluded portal vein; service type: open vascular surgical reconstruction, typical site of service: inpatient operating room or transplant surgery suite.

    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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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99291Critical care, evaluation and management of the critically ill or critically injured patient; first 30–74 minutesPostoperative ICU management for graft dysfunction or hemodynamic instability after renoportal anastomosis
    36478Endovascular stenting of venous occlusion or stenosis, including angioplasty when performed; initial vesselMay be performed preoperatively or postoperatively for portal or mesenteric venous interventions as an alternative or adjunct to open reconstruction
    34830Transplantation, liver; implantation (separate from procurement)Contextual code for the host liver graft surgery; relevant in the transplant care continuum though not billed concurrently for the revision
    76937Ultrasonic guidance for vascular access (e.g., duplex Doppler intraoperative flow assessment)Used intraoperatively or perioperatively to document assessment of portal/renal vein flow
    39501Incision and repair of iliac or femoral vein; openRepresents comparable open venous repair technique code; included as related vascular reconstruction example

    Related Modifiers

    11 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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due 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…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208100000X
    208600000X
    207V00000X
    208000000X
    208800000X
    2084F0202X
    207K00000X
    207N00000X

    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-37140-PORTOCAVAL-SHUNT-PORTAL-HYPERTENSION-SURGERY

    CPT 37140: Portocaval Shunt Creation for Portal Hypertension

    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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