General Surgery Coding Alert

Reporting a Whipple procedure can be a cinch, as long as you recognize the various names by which surgeons may call this surgery, as well as the confusion of terminology that describes the options that can occur during the procedure. Here are some tips to help you on your way.

Be aware that your surgeon may not always refer to a Whipple as a Whipple. Other common names for the procedure include pancreaticoduodenectomy, pancreat-ectomy with duodenectomy, pylorus-sparing pancreaticoduodenectomy or Traverso-Longmire procedure, and Kausch or Kausch-Whipple procedure.

Regardless of what you call it, you will report a Whipple using one of four codes, depending on the procedure's specifics:

All Whipple procedures involve removing the head of the pancreas (pancreat-ectomy) and at least a portion of the duodenum (duodenectomy), and joining of the common bile duct to the intestine (choledochoenterostomy), says Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, manager of compliance education at the University of Washington Physicians.

As indicated by the 48150-48154 descriptors, a Whipple procedure may also include removing a portion of the stomach (partial gastrectomy), and creating a link between the stomach and the jejunum (gastrojejunostomy); the duodenum and the jejunum (duodenojejunostomy); or the jejunum and a pancreatic duct, cyst or fistula (pancreatojejunostomy).

To make your code selection easier, scan the op note to determine whether the surgeon removed all, or only a portion, of the duodenum (the first or proximal portion of the small intestine).

For a total duodenectomy, you will look to either 48150 or 48152. For a partial duodenectomy, either 48153 or 48154 is appropriate. In either case, whether the surgeon also performs a pancreatojejunostomy will determine the final code selection, Bucknam says.

Tip: If the surgeon performs a partial gastrectomy and gastrojejunostomy, the procedure will have included a total duodenectomy. If the surgeon performs duodeno-jejunostomy, however, this is evidence that he has spared the pylorus (and thus normal gastric emptying), and only a partial duodenectomy has occurred.

If the surgeon performs jejunostomy during the same operative session as pancreatectomy, you should report 48150 or 48153, depending on whether the surgeon also performed a partial or complete duodenectomy.

A Whipple procedure usually (but not always) includes removal of the gallbladder and ligature of the cystic duct as described in most standard surgical texts, says M. Trayser Dunaway, MD, a surgeon, coding educator and healthcare consultant in Camden, S.C.

The national Correct Coding Initiative bundles open cholecystectomy (47600) to all Whipple procedures, and as a result you should not report 47600 separately with 48150-48154.