Summary & Overview
CPT 48148: Removal of Ampulla of Vater (Ampullectomy)
CPT code 48148 denotes surgical removal of the ampulla of Vater, a specialized operative procedure that addresses disease processes at the junction of the common bile duct and pancreatic duct. Nationally, this code represents a high-acuity surgical service typically performed in hospital operating rooms or tertiary surgical centers by hepatopancreatobiliary or general surgeons with advanced biliary expertise. It matters because ampullectomy procedures carry significant clinical complexity, perioperative risk, and resource utilization, with implications for hospital coding, payer coverage, and postoperative care pathways.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks and context for clinical coding, an outline of expected sites of service, and guidance about where this procedure sits within surgical and billing workflows. The publication highlights clinical context for indications such as obstructive jaundice or ampullary neoplasm, typical care settings, and common billing considerations associated with operative services of this scope.
The piece is intended for revenue-cycle professionals, surgical coders, clinical leaders, and policy analysts seeking a national-level briefing on coding practice, coverage interfaces, and clinical placement of ampullary excision services.
Billing Code Overview
CPT code 48148 describes surgical removal of the ampulla of Vater, the confluence of the common bile duct and pancreatic duct. This procedure involves excision of the ampullary tissue to address obstructive, neoplastic, or other pathological conditions affecting biliary and pancreatic outflow.
Service Type: Surgical excision of ampulla of Vater
Typical Site of Service: Hospital operating room or tertiary surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55–75 year-old individual presenting with obstructive jaundice, recurrent cholangitis, or periampullary neoplasm identified on imaging (CT/MRI) or endoscopic evaluation. After diagnostic workup including liver function tests, abdominal imaging, and endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS), the surgical team elects for resection of the ampulla of Vater when the lesion is localized to the ampullary region and not amenable to local endoscopic therapy or when malignancy is suspected and local excision is appropriate.
Preoperative workflow includes multidisciplinary evaluation (gastroenterology, surgical oncology, anesthesia), informed consent, optimization of comorbidities, and marking of planned site of resection. Intraoperative workflow involves general anesthesia, exposure of the second portion of the duodenum, identification of the ampulla and intraduodenal ducts, careful dissection and excision of the ampullary complex with attention to the common bile duct and pancreatic duct confluence, and reconstruction of ductal drainage (e.g., ductal reimplantation or local anastomosis). Postoperative care focuses on monitoring for bile leak, pancreatitis, hemorrhage, and sepsis, with serial labs and imaging as indicated. Pathology evaluation of the specimen guides any further oncologic therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when substantial additional work or complexity beyond typical is documented (e.g., extensive adhesiolysis or complex reconstruction). |