Summary & Overview
CPT 47146: Liver Graft Vein Graft Attachment
CPT code 47146 codes for the surgical attachment of a vein graft to a vein segment on a liver graft to provide a single, suitably long vein for anastomosis to the recipient’s vein. This procedure is a component of liver transplantation and graft preparation and has implications for operative planning, supply utilization, and billing clarity across transplant centers nationwide. National attention to accurate coding for transplant-related surgical components supports appropriate payment, quality reporting, and resource tracking.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The review outlines typical clinical context for the code, site-of-service expectations, and common procedural modifiers used in billing practice. Readers will find benchmarks and practical guidance on documentation elements that support use of this code, an overview of payer coverage considerations, and summaries of relevant policy updates where available. The publication also situates 47146 within related procedural coding to aid clinical coders and revenue professionals in ensuring consistent reporting.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and payer-specific contract language is noted where applicable.
Billing Code Overview
CPT code 47146 describes a surgical procedure in which a provider attaches a vein graft to a vein segment on a liver graft to create a single vein of adequate length for anastomosis to the recipient patient’s vein. The procedure is performed as part of liver transplantation or hepatic graft preparation.
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Service type: Surgical graft preparation for transplantation
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Typical site of service: Operating room or transplant surgical suite
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–65-year-old adult undergoing orthotopic liver transplantation for end-stage liver disease (for example, cirrhosis from hepatitis C or alcohol-related liver disease). During back-table preparation of the donor liver graft, the transplant surgeon identifies that the donor hepatic venous outflow requires reconstruction to provide a single, adequately long venous conduit for anastomosis to the recipient's vena cava or hepatic vein. The surgeon harvests an autologous or allogeneic vein graft (such as an iliac vein or donor portal vein segment) and attaches it to a segment of the donor liver graft vein to create a single cuff or conduit.
The clinical workflow includes preoperative planning by the transplant team, donor organ procurement, back-table bench surgery where 47146 is performed to fashion the venous outflow, transportation of the reconstructed graft to the operating room, and implantation with vascular anastomoses to recipient vessels. Intraoperative vascular assessment (patency and length) follows the reconstruction, and the transplant is completed with standard biliary and arterial anastomoses. Postoperatively, the patient is monitored in the intensive care unit for hemodynamic stability and graft function, with imaging surveillance (Doppler ultrasound, CT) to evaluate venous outflow.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, established procedure |