Summary & Overview
CPT 48146: Near Total Pancreatectomy, Major Abdominal Surgery
CPT code 48146 denotes a near total pancreatectomy, a major abdominal operation removing most of the pancreas. This procedure is clinically significant for patients with diffuse or extensive pancreatic pathology where preservation of minimal pancreatic tissue is planned. Nationally, billing and coverage for high-complexity pancreatic resections like this affect hospital surgical services, inpatient resource utilization, and specialty surgical care pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for 48146, common payer coverage considerations, and benchmarking topics relevant to high-acuity surgical billing. The publication addresses coding specificity, typical settings of service, and implications for inpatient surgical resource allocation.
The report provides practical reference material: a concise description of the procedure and service line, payer coverage list, typical sites of service, and points of focus for revenue cycle and clinical operations. Data not available in the input are noted where applicable. The content is intended for health system administrators, clinical coders, and policy analysts seeking a national-level summary of CPT code 48146 and its role in surgical care and billing workflows.
Billing Code Overview
CPT code 48146 describes a near total pancreatectomy, a surgical procedure in which the provider removes most of the pancreas. The service is a major abdominal surgical operation performed to treat extensive pancreatic disease when preservation of only a small portion of pancreatic tissue is intended.
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Service type: Major abdominal surgical procedure
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Typical site of service: Hospital inpatient operating room or other inpatient surgical setting
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with a history of multifocal, non-resectable pancreatic neuroendocrine tumor presents with progressive endocrine dysfunction and refractory abdominal pain. After multidisciplinary tumor board review and failed attempts at organ-preserving therapy, the surgical team schedules a near total pancreatectomy to remove the majority of the pancreas while preserving minimal pancreatic tissue to maintain some endocrine/exocrine function.
Preoperative workflow includes cross-sectional imaging (CT or MRI), endocrine and nutritional assessment, optimization of glycemic control, informed consent covering risks (bleeding, infection, pancreatic fistula, brittle diabetes), and coordination with anesthesia and blood bank for potential transfusion. Intraoperative workflow involves laparotomy or minimally invasive access, dissection of pancreatic tissue, vascular control, possible splenectomy depending on oncologic margins and vascular involvement, reconstruction as indicated, placement of drains, and hemostasis. Postoperative management focuses on intensive monitoring, pain control, glycemic management (insulin therapy), enzyme supplementation, infection surveillance, and discharge planning with endocrine and nutrition follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedural modifier for unspecified purpose (payer-specific use) | Rarely used; follow payer guidance when no other modifier applies |