Summary & Overview
CPT 37160: Caval–Mesenteric Venous Anastomosis for Portal Hypertension
CPT code 37160 documents an open surgical caval–mesenteric venous anastomosis connecting the superior mesenteric vein to the inferior vena cava. The procedure is clinically significant for managing portal hypertension and for establishing direct portal-system access for targeted drug delivery. Nationally, this code captures complex vascular surgery typically performed in tertiary centers or hospital operating rooms and has implications for surgical resource use and specialty reimbursement.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent and typical care setting for the service, plus a summary of common modifiers associated with surgical coding for complex operations. The publication highlights what readers can expect regarding benchmarks and policy context: coding definitions, typical sites of service, and payer coverage considerations where available. Data not provided in the input—such as associated taxonomies, specific ICD-10 diagnoses, related CPT codes, and detailed payer-specific reimbursement rates—are noted as unavailable. The summary is intended to support billing staff, surgical service line managers, and policy analysts in interpreting the clinical and administrative purpose of CPT code 37160.
Billing Code Overview
CPT code 37160 describes a surgical procedure in which the provider makes an abdominal incision and creates a caval–mesenteric venous anastomosis, connecting the superior mesenteric vein to the inferior vena cava. This operative connection is used to treat portal hypertension and to provide direct access to the portal system for delivery of therapies.
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Service type: Open surgical vascular anastomosis of portal and systemic venous structures
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Typical site of service: Operating room in an acute care hospital or tertiary surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 50–65-year-old with decompensated cirrhosis complicated by refractory portal hypertension and recurrent variceal bleeding or symptomatic portal-systemic shunt failure. The patient presents after failed endoscopic, pharmacologic, and radiologic measures to control portal pressures and bleeding. Preoperative evaluation includes hepatic function assessment (Child-Pugh and MELD scores), cross-sectional abdominal imaging (CT or MRI) to define vascular anatomy, coagulation profile, and discussion of operative risk with anesthesia and transplant teams when appropriate.
In the operating room under general anesthesia, the surgical team performs a midline laparotomy to expose the portal venous system and inferior vena cava. The superior mesenteric vein is mobilized, and an anastomosis is fashioned between the superior mesenteric vein and the inferior vena cava (caval-mesenteric venous anastomosis). The procedure reduces portal venous pressure, treats refractory variceal hemorrhage or portal hypertension complications, and can provide direct portal access for targeted drug delivery when indicated. Postoperative care includes intensive monitoring of hemodynamics, assessment for hepatic encephalopathy, anticoagulation management as indicated, and serial imaging to ensure patency of the anastomosis. Discharge planning involves coordination with hepatology and interventional radiology for long-term portal flow surveillance and management of underlying liver disease.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |