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CPT 37180: Proximal Splenorenal Venous Anastomosis

CPT code 37180 represents open abdominal vascular surgery to create a proximal splenorenal venous anastomosis, often performed during splenectomy or procedures to address portal hypertension. Nationally, this code identifies complex intra-abdominal vascular reconstruction with implications for inpatient surgical case mix, resource use, and coding accuracy across hospital systems. Key payers relevant to national coverage and reimbursement patterns include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of clinical context, common sites of service, and the procedural intent behind CPT code 37180. The publication provides benchmarks and coding considerations relevant to surgical service lines, highlights clinical scenarios where the procedure is used, and notes national payer coverage groups included in the review. Data not available in the input is noted where applicable. This summary serves clinicians, coding professionals, and policy analysts seeking a national-level understanding of the code’s clinical role and billing classification.

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Billing Code Overview

CPT code 37180 describes a surgical procedure in which the provider creates a proximal splenorenal venous anastomosis — a connection between the splenic vein and the renal vein — typically through an incision in the abdomen. The procedure is commonly performed in conjunction with splenectomy or during operations addressing portal hypertension and variceal bleeding where diverting splenic venous flow to the renal vein is clinically indicated.

Service type: Open abdominal vascular surgery involving venous anastomosis
Typical site of service: Inpatient operating room or surgical suite during abdominal surgery

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CPT 37180: Proximal Splenorenal Venous Anastomosis

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Billing Code Overview

Service type: Open abdominal vascular surgery involving venous anastomosis
Typical site of service: Inpatient operating room or surgical suite during abdominal surgery

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.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity significantly exceeds typical for `37180`.
`23`	Unusual anesthesia	Use when procedure performed under general anesthesia because of patient condition and anesthesia services are unusual for the procedure.
`26`	Professional component	Use when reporting only the physician’s professional component for a related diagnostic imaging study if billed separately.
`50`	Bilateral procedure	Use if bilateral procedures are reported and modifier applies (rare for `37180`).
`51`	Multiple procedures	Use when `37180` is performed with other distinct procedures during the same operative session.
`52`	Reduced services	Use when procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when procedure is terminated for patient-related or surgical reasons before completion.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of `37180`.
`76`	Repeat procedure by same physician	Use if the identical procedure `37180` is repeated later same day by the same physician.
`78`	Unplanned return to the operating room for a related procedure by the same physician following initial `37180` during the postoperative period.	Use when a return to OR is required for complications related to the original procedure.
`80`	Assistant surgeon	Use when a surgical assistant (physician) is documented and required for `37180`.
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon is documented.
`82`	Assistant surgeon (when qualified resident not available)	Use when no qualified resident is available and an assistant surgeon is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when a qualified non-physician practitioner performs part or all of the service under appropriate state law and payer rules.

Taxonomy Code	Specialty	Notes
207K00000X	General Surgery	Most common specialty performing open splenectomy with splenorenal shunt.
2080P0207X	Vascular Surgery	Performs complex venous anastomoses and portal decompression procedures.
208100000X	Thoracic Surgery	Occasionally involved for access or when combined thoracoabdominal procedures are required.
207R00000X	Colon & Rectal Surgery	May participate when combined abdominal procedures are present.
208D00000X	Transplant Surgery	Involved when portal hypertension management overlaps with transplant or complex hepatic surgery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K76.6`	Portal hypertension	Primary indication for creating a proximal splenorenal shunt to decompress portal system and reduce variceal bleeding.
`I85.01`	Esophageal varices with bleeding	Complication of portal hypertension; shunt creation can reduce rebleeding risk.
`D73.5`	Hypersplenism	Indication for splenectomy often combined with shunt procedures to address cytopenias and portal hypertension.
`K75.1`	Chronic hepatic congestion	Underlying liver pathology contributing to portal hypertension and need for decompressive shunt.
`I85.00`	Esophageal varices without bleeding	Indication for prophylactic portal decompression in select patients with recurrent varices.

Related CPT Codes

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

CPT 37140: Portocaval Shunt for Portal Hypertension

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

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-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 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
`22`	Increased procedural services	Use when work, time, or complexity significantly exceeds typical for `37180`.
`23`	Unusual anesthesia	Use when procedure performed under general anesthesia because of patient condition and anesthesia services are unusual for the procedure.
`26`	Professional component	Use when reporting only the physician’s professional component for a related diagnostic imaging study if billed separately.
`50`	Bilateral procedure	Use if bilateral procedures are reported and modifier applies (rare for `37180`).
`51`	Multiple procedures	Use when `37180` is performed with other distinct procedures during the same operative session.
`52`	Reduced services	Use when procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when procedure is terminated for patient-related or surgical reasons before completion.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of `37180`.
`76`	Repeat procedure by same physician	Use if the identical procedure `37180` is repeated later same day by the same physician.
`78`	Unplanned return to the operating room for a related procedure by the same physician following initial `37180` during the postoperative period.	Use when a return to OR is required for complications related to the original procedure.
`80`	Assistant surgeon	Use when a surgical assistant (physician) is documented and required for `37180`.
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon is documented.
`82`	Assistant surgeon (when qualified resident not available)	Use when no qualified resident is available and an assistant surgeon is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when a qualified non-physician practitioner performs part or all of the service under appropriate state law and payer rules.

Taxonomy Code	Specialty	Notes
207K00000X	General Surgery	Most common specialty performing open splenectomy with splenorenal shunt.
2080P0207X	Vascular Surgery	Performs complex venous anastomoses and portal decompression procedures.
208100000X	Thoracic Surgery	Occasionally involved for access or when combined thoracoabdominal procedures are required.
207R00000X	Colon & Rectal Surgery	May participate when combined abdominal procedures are present.
208D00000X	Transplant Surgery	Involved when portal hypertension management overlaps with transplant or complex hepatic surgery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K76.6`	Portal hypertension	Primary indication for creating a proximal splenorenal shunt to decompress portal system and reduce variceal bleeding.
`I85.01`	Esophageal varices with bleeding	Complication of portal hypertension; shunt creation can reduce rebleeding risk.
`D73.5`	Hypersplenism	Indication for splenectomy often combined with shunt procedures to address cytopenias and portal hypertension.
`K75.1`	Chronic hepatic congestion	Underlying liver pathology contributing to portal hypertension and need for decompressive shunt.
`I85.00`	Esophageal varices without bleeding	Indication for prophylactic portal decompression in select patients with recurrent varices.

Related CPT Codes

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

CPT 37140: Portocaval Shunt for Portal Hypertension

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

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-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 37180: Proximal Splenorenal Venous Anastomosis

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Billing Code Overview

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CPT 37180: Proximal Splenorenal Venous Anastomosis

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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