Liver Normothermic Pump Surgical CPT Codes

New CPT Category III codes for the surgical work and time involved in preparing and placing a liver allograft onto a normothermic perfusion device and decannulating the liver will be available beginning July 1, 2024.

The codes are listed below with their official descriptions: X261T, X262T, and X263T.

These new Category III CPT codes do NOT have any RVUs connected to them; a documented use of these codes with proper reporting to CMS is required before moving these codes to Category I and receiving formal RVUs and payment. For future RUC processes, an estimated usage of these codes will determine their RVU assignment.

Please submit these CPT codes even though there is no payment currently.

ASTS Guide on Professional Coding

The ASTS Business Practice Services Committee and Legislative and Regulatory Committee are happy to update the original 2012 CPT guide for transplant professionals with 2024 information.

We hope that you find this handy guide easy to use and helpful. Please refer to your latest edition of the American Medical Association (AMA) CPT Professional Edition for additional codes, terminology, rules, and guidelines and discuss this with your professional and hospital coding specialists.  We also are supplying free online resources on the CMS website that are updated with new information every year.

Respectfully Submitted,

Ken Andreoni, MD, FACS

View the coding guide as a PDF!

Heart/Lung Transplantation

Recipient heart with or without lung allotransplantation

(For artificial heart systems with cardiectomy, see category III codes 0051T-0053T)

33930 Donor cardiectomy-pneumonectomy including cold preservation

33933 Backbench preparation of cadaver donor heart/lung prior to transplantation

33935 Heart-lung transplant with recipient cardiectomy-pneumonectomy

33940 Donor cardiectomy (including cold preservation)

33944 Backbench preparation of cadaver donor heart prior to transplantation

33945 Heart transplant, with our without recipient cardiectomy

Intestinal Transplantation

Allograft Preparation

44715 Backbench preparation of cadaver or living donor intestine prior to transplantation

44720 Backbench reconstruction of cadaver or living donor allograft, venous anastomosis, each

44721 Backbench reconstruction of cadaver or living donor allograft, arterial anastomosis, each

44799 Unlisted procedure, intestine

Allotransplantation

44135 Intestinal allotransplantation, from cadaver donor

44136 From living donor

44137 Removal of transplanted intestinal allograft, complete

44139 Mobilization of splenic flexure performed in conjunction with partial colectomy

44140 Colectomy, partial with anastomosis

44015 Needle catheter jejunostomy (surgical feeding tube)

43500 Gastrostomy, exploration (surgical G-tube)

Donor Enterectomy

44132 Donor enterectomy (including preservation), open from cadaver

44133 partial, from living donor

Other Liver Procedures

47350 Management of liver hemorrhage, simple suture

47360 complex suture of liver wound or injury

47361 extensive debridement, coagulation w w/o packing

47362 re-exploration of hepatic wound for removal of packing

48000 Drainage of abdomen

49000 Exploration of Abdomen

49002 Re-Opening of Abdomen

35840 Re-Opening for hemorrhage (some coders may not allow this for abd)

Lung Transplantation

32850 Donor pneumonectomy(s)(including cold preservation)

32851 Lung transplant, single; without cardiopulmonary bypass

32852 with cardiopulmonary bypass

32853 Lung transplant, double (bilateral sequential or en bloc)

32854 with cardiopulmonary bypass

32855 Backbench standard preparation of single cadaver donor lung allograft

32856 Backbench bilateral lung preparation

Pancreas Transplantation

48160 Pancreatectomy, total or subtotal, with autologous transplantation of pancreas or islet cells

48550 Donor pancreatectomy (including cold preservation), with or without duodenal segment for transplantation

48551 Backbench standard preparation of cadaver donor allograft prior to transplantation including splenectomy, duodenotomy, CBD ligation, Y graft arterial anastomosis

48552 Backbench reconstruction of donor pancreas, venous anastomosis, each

48554 Transplantation of pancreas allograft

48556 Removal of transplanted pancreatic allograft

48999 Unlisted procedure, pancreas

Renal Transplantation

50300 Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral

50320 Remove kidney open from living donor (Donor Nephrectomy)

50323 Backbench standard preparation of cadaver donor renal allograft prior to transplantation.

50325 Backbench standard preparation of living donor renal allograft prior to transplantation

50327 Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis each

50328 arterial anastomosis, each

50329 ureteral anastomosis, each

50340 Recipient nephrectomy (separate procedure; removal of native kidney)

50360 Renal allotransplantation, implantation of graft; without recipient nephrectomy 

50365 with recipient nephrectomy

50370 Removal of transplanted renal allograft

50380 Renal autotransplantation, reimplantation of kidney 

50605 Insertion of indwelling stent, all types 

50500 Repair of kidney wound

50547 Lap removal donor kidney (Lap donor nephrectomy)

50760 Fusion of ureters

50780 Reimplant of ureter in bladder

52310 Cystoscopy with simple removal of ureteral stent

Hemodialysis Access

36800 Insertion of cannula for hemodialysis 36810 arteriovenous, external (Scribner type)

36815 arteriovenous, external revision, or closure

36818 Arteriovenous anastomosis, open; upper arm cephalic vein transposition

36819 Arteriovenous anastomosis, open; upper arm basilic vein transposition

36820 Arteriovenous anastomosis, open; by forearm vein transposition

36821 Arteriovenous anastomosis, open; direct, any site (eg Cimino type)

Peritoneal Dialysis Catheter

49422 Removal PD Catheter

49421 Open placement PD Catheter

49324 Laparoscopic placement PD Catheter (Omentopexy add-on 49326)

49435 Add on for subcutaneous extension of catheter (eg to chest in obese patient)

49436 Delayed creation of exit site for previously embedded subcutaneous PD Catheter

Abdominal Wall Hernias: (new 2023)

49591 Any anterior abd wall initial, reducible hernia (open or lap), includes mesh if used, less than 3 cm (same, but recurrent hernia: 49613)

49592 – as above, incarcerated or strangulated less than 3 cm (recurrent 49614)

49593 – as 49591 (reducible), but 3 to 10 cm total length (recurrent 49615)

49594 – as 49592 (incarcerated / strangulated), but 3 to 10 cm total length (recur 49616)

49595 – as 49591 (reducible), but > 10 cm total length (recurrent 49617)

49596 - as 49592 (incarcerated / strangulated), but > 10 cm total length (recurrent 49618)

Commonly Used Procedure Modifiers

22* Unusual procedure. Use this for procedures that require additional work (e.g. lysis of adhesions, retransplant etc) or are very difficult. * must specify level of difficulty 25%, 50%, 75% or 100% more than usual. Op note must support level. TAllows for additional charges based on percent specified.

58 Staged Procedure. Use this for planned take back operation. (abdominal packing for 24 hours, etc) . Allows for additional charge above primary procedure.

62 Two Surgeons/Different Skills. Use this when two attendings perform a case together and can split the case into two parts. Requires two operative notes from each surgeon to add up to one whole case. (e.g. One surgeon dictates backbench and implant graft; other surgeon dictates native organ removal). Allows charges at 125% rather than usual 110% (100% attending, 10% assistant fee).

80 Assistant Surgeon

82 Assistant Surgeon when no qualified resident is available.

80 or 82 Allows 10% assistant fee per CMS guidelines. Standard major transplant operations qualify (50360.82, 47135.82, 48544.82). Documentation of the non-availability of a qualified resident is suggested.

See CPT book for additional codes and modifiers.

Additional Resources:

• CPT code and RVU online resources;
• 2024 all RVUs in downloaded zip excel files;
• RVU files all years;
• CMS Physician Fee Schedule.

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