CPT® Code 48140

The CPT® Code 48140 refers to a surgical procedure known as a distal subtotal pancreatectomy, which may or may not include the removal of the spleen (splenectomy). This procedure is performed through a subcostal or midline incision in the abdomen, allowing access to the pancreas and surrounding structures. The operation involves the careful division of the gastrocolic and colosplenic ligaments to mobilize the duodenum and the head of the pancreas. The peritoneum is then incised along the inferior border of the pancreas, facilitating blunt dissection to separate the body and tail of the pancreas from the posterior abdominal wall. If the spleen is to be removed, the surgical dissection extends from the superior mesenteric vein to the hilum of the spleen, where the splenic artery is identified, divided, and doubly ligated. The spleen is subsequently freed from its attachments to the diaphragm. During the procedure, both the spleen and the distal pancreas are retracted to visualize the inferior mesenteric vein, while the splenic vein is preserved. The mesentery of the uncinate process is ligated and divided, allowing for the removal of the body and tail of the pancreas. It is important to note that in this specific procedure, there is no pancreaticojejunostomy performed, which distinguishes it from similar procedures such as CPT® Code 48145, where such an anastomosis is included. The pancreatic duct is identified, and drainage to the duodenum is confirmed before the pancreas is closed with interrupted mattress sutures. The surgical site is then flushed with normal saline, and drains are placed before the abdomen is closed around them. This detailed description outlines the complexity and precision required in performing a distal subtotal pancreatectomy without pancreaticojejunostomy.