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    OpenPayerBilling CodesPortal Decompression Procedures on Arteries and VeinsCPT cpt-37180-proximal-splenorenal-venous-anastomosis
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    CPT 37180: Proximal Splenorenal Venous Anastomosis

    Medicare pays $1969 on average nationally for this procedure.

    CPT code 37180 describes a surgical procedure in which the surgeon creates a proximal splenorenal venous anastomosis (a connection between the splenic vein and the renal vein), typically performed through an abdominal incision and often at the time of splenectomy; service type: open vascular shunt creation (portal-systemic shunt) associated with spleen surgery; typical site of service: inpatient operating room or surgical suite during abdominal surgery.

    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 typical patient is a 45–65-year-old with portal hypertension and complications from portal-systemic shunting or hypersplenism undergoing open abdominal surgery. The surgeon performs a proximal splenorenal shunt (splenic vein to left renal vein anastomosis) most often at the time of splenectomy to decompress the portal venous system and reduce variceal bleeding risk. The clinical workflow includes preoperative imaging (abdominal ultrasound, CT or MR angiography) and laboratory evaluation (CBC, coagulation panel, liver function tests). In the operating room under general anesthesia, an upper midline or left subcostal abdominal incision is made, the spleen is mobilized and removed when indicated, the splenic vein is isolated and anastomosed to the left renal vein to create a proximal splenorenal venous anastomosis, and hemostasis is secured. Postoperative monitoring focuses on hemodynamics, abdominal drain output if placed, surveillance for bleeding, renal function, and signs of shunt patency or thrombosis. Typical postoperative care occurs in a surgical ward or step-down unit with imaging follow-up (Doppler ultrasound or CT venography) as indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    32620Thoracotomy, with exploration and repair of major intrathoracic blood vessels; repair, with or without cardiopulmonary bypassUncommon; listed here when extensive thoracoabdominal exposure or vascular control is required for complex portal decompression procedures.
    38100Splenectomy, partial or total, for trauma or nonmalignant disease; with or without autotransplantationOften performed immediately before or during creation of a splenorenal shunt when splenectomy is indicated.
    36245Selective catheter placement, arterial, venous, or lymphatic (separate vascular access) for diagnostic study or interventional procedureUsed preoperatively for portal venography or intraoperative catheter-based assessment of portal pressures.
    76937Ultrasound guidance for paracentesis or thoracentesisMay be used perioperatively for ultrasound-guided vascular access or abdominal fluid assessment; supportive imaging during planning.
    36147Introduction of needle and catheter into peripheral vein for diagnostic or therapeutic purposes, percutaneous, with imaging guidanceMay be used for central or peripheral venous access related to perioperative management.

    Related Modifiers

    13 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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    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 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    2080P0207X
    208100000X
    207R00000X
    208D00000X
    103TM1800X
    111NN1001X
    175L00000X

    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-37145-RENOPORTAL-VENOUS-ANASTOMOSIS-RENAL-TO-PORTAL-VEIN

    CPT 37145: Renoportal Venous Anastomosis for Portal Flow Restoration

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

    CPT 37160: Caval–Mesenteric 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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