Summary & Overview
CPT 48152: Subtotal Pancreatectomy with Duodenectomy and Reconstruction
CPT code 48152 represents a complex major abdominal surgery — subtotal pancreatectomy with duodenectomy, partial bile duct resection, distal gastrectomy, and reconstructive procedures performed without a pancreatic-to-jejunal anastomosis. This procedure is clinically significant because it addresses extensive pancreatic and periampullary disease while avoiding a pancreaticojejunostomy, which can affect postoperative risk profiles such as pancreatic fistula. Nationally, the code is used to categorize resource-intensive inpatient surgical care with implications for hospital billing, case-mix measurement, and quality reporting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical intent and settings for CPT code 48152, common modifiers used with major surgical claims, and the typical inpatient surgical context for payment and utilization reviews. The publication also outlines areas relevant to benchmarking and policy updates, including inpatient reimbursement considerations and clinical documentation elements tied to major abdominal resections.
This summary provides clinicians, coding professionals, and policy analysts with the context needed to interpret claims using CPT code 48152, understand where the service is typically delivered, and identify topics to review when assessing coding accuracy and hospital resource use. Data not available in the input regarding associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 48152 describes a surgical procedure in which the provider removes most of the pancreas (subtotal pancreatectomy) along with the duodenum, part of the bile duct, and the distal stomach, followed by reconstruction without creating a pancreaticojejunostomy (no pancreatic-to-jejunal anastomosis).
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Service type: Major abdominal resection with gastrointestinal and biliary reconstruction
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Typical site of service: Hospital inpatient setting, operating room with postoperative inpatient hospitalization
Clinical & Coding Specifications
Clinical Context
A typical patient is a 60–75-year-old adult presenting with a resectable pancreatic head malignancy (for example, adenocarcinoma) or high-grade dysplasia/neoplasm of the ampulla, distal bile duct, or periampullary region. The patient commonly has progressive jaundice, weight loss, abdominal pain, and abnormal liver function tests. Preoperative workup includes contrast-enhanced CT or MRI, endoscopic ultrasound with biopsy, staging labs, and optimization of nutrition and comorbidities. The operative plan is a pancreaticoduodenectomy (Whipple) with antrectomy and reconstruction in which the majority of the pancreas, the duodenum, the distal bile duct, and part of the stomach are removed. Reconstruction is performed without creating a pancreatojejunostomy (for example, pancreatoenteric drainage not performed or external pancreatic duct drainage). Typical intraoperative teams include an attending hepatopancreatobiliary surgeon, anesthesiology, surgical assistants, and nursing; postoperative care includes intensive monitoring for hemorrhage, anastomotic leak, pancreatic fistula, delayed gastric emptying, and glycemic control. The procedure is usually performed in an inpatient hospital operating room under general anesthesia. Typical sites of service are acute care hospitals or tertiary referral centers with complex surgical services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Used when no specific modifier applies and service is reported as standard. |