Summary & Overview
CPT 48145: Distal Pancreatectomy With or Without Splenectomy
CPT code 48145 denotes distal pancreatectomy — removal of the tail and/or body of the pancreas, with optional splenectomy and, when necessary for ductal obstruction, creation of a pancreaticojejunostomy. This code represents a major abdominal surgical procedure with implications for surgical subspecialties, hospital resource use, and post-operative care. Nationally, procedures captured by this code are relevant for policy discussions on surgical outcomes, resource allocation, and bundled payment models for complex pancreatic surgery.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of procedural benchmarks, payer coverage patterns, and clinical context for use of the code. The publication outlines typical sites of service and common clinical scenarios that trigger use of this code, summarizes available reimbursement and coverage considerations, and highlights areas where coding specificity affects claims processing and payment. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 48145 describes surgical removal of the distal portion of the pancreas, performed with or without concurrent removal of the spleen. The procedure also includes, when indicated for pancreatic duct obstruction, creation of an anastomosis connecting the pancreas to the jejunum.
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Service Type: Surgical resection of the pancreas (distal pancreatectomy), with possible splenectomy and pancreaticojejunostomy when needed
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Typical Site of Service: Inpatient hospital or ambulatory surgery center for major abdominal surgery
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55–70-year-old adult presenting with symptomatic disease of the distal pancreas such as a solitary pancreatic neoplasm in the body or tail (adenocarcinoma, neuroendocrine tumor), or chronic pancreatitis with intractable pain or ductal obstruction localized to the distal gland. The workflow begins with preoperative evaluation including cross-sectional imaging (contrast CT or MRI) and endoscopic ultrasound with biopsy as indicated, staging and medical optimization, and discussion at a multidisciplinary conference when cancer is suspected. On the day of surgery the patient undergoes a distal pancreatectomy, often with concurrent splenectomy if oncologic margins or vascular anatomy require removal of the spleen. In patients with pancreatic duct obstruction where drainage is required, a pancreaticojejunostomy (anastomosis of the pancreatic remnant to the jejunum) may be performed. Intraoperative considerations include possible vascular control, proximal pancreatic transection, assessment for frozen section, and placement of surgical drains. Typical postoperative care includes pain control, monitoring for pancreatic fistula, management of drains, immunization counseling if splenectomy performed, and follow-up for adjuvant therapy if malignancy is confirmed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard reporting — no modifier | Rarely used explicitly; indicates no special modifier when system requires a two-character code — typically not appended by providers |