General Surgery Coding Alert

CPT 2005 will include a host of codes for backbench preparation or reconstruction of donor organs. These new codes cover backbench standard preparation of cadaver donor lung, heart/lung or pancreas allograft prior to transplant. They also include backbench reconstruction of cadaver or living donor intestine or liver graft or allograft prior to transplantation. The codes include:

44715 - Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein

44720 - Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; venous anastomosis, each

44721 - ... arterial anastomosis, each

47143 - Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; without trisegment or lobe split

47144 - ... with trisegment split of whole liver graft into two partial liver grafts (i.e., left lateral segment [segments II and III] and right trisegment [segments I and IV through VIII])

47145 - ... with lobe split of whole liver graft into two partial liver grafts (i.e., left lobe [segments II, III, and IV] and right lobe [segments I and V through VIII])

47146 - Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; venous anastomosis, each

47147 - ... arterial anastomosis, each

48551 - Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and Y-graft arterial anastomoses from iliac artery to superior mesenteric artery and to splenic artery

48552 - Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each.
 
The new proposed codes also include 44137 (Removal of transplanted intestinal allograft, complete).
 
The American Society of Transplant Surgeons pushed for the new codes to reflect the past two decades' worth of technical advances, according to Michael Abecassis, chairman of the ASTS Reimbursement Committee. Surgeons can now use donor organs that they would have considered unusable in the past, including organs with anomalous vascular anatomy. Using microvascular suture techniques and improved surgical skills to rescue these organs, surgeons have also developed techniques such as liver splits to maximize the use of donor organs.
 
The ASTS also pushed to remove the phrase "with preparation and maintenance of the allograft" from current liver donor code descriptors, because it doesn't accurately describe these backbench procedures.
 
Surgeons can perform backbench preparation and reconstruction at either the donor or the recipient site of service, Abecassis says. Also, a recipient may die and the surgeon may have to send the graft to a different site for a different recipient.