38100

Total Splenectomy

CPT code 38100 refers to a total splenectomy, which is the complete surgical removal of the spleen. This procedure is traditionally performed via an open abdominal approach, known as a laparotomy. The spleen is a highly vascular lymphoid organ located in the left upper quadrant of the abdomen, tucked beneath the diaphragm and rib cage. It serves vital physiological functions, including filtering aged or damaged red blood cells, storing platelets, and facilitating immune responses to encapsulated bacteria. A total splenectomy is indicated for various conditions ranging from acute emergencies to chronic hematologic diseases. In the emergency setting, it is most frequently performed for a ruptured spleen due to blunt or penetrating abdominal trauma, where life-threatening hemorrhage necessitates immediate removal. In elective settings, it is often the treatment of choice for hematologic disorders that do not respond to medical management, such as immune thrombocytopenic purpura (ITP), hereditary spherocytosis, or symptomatic hypersplenism. It may also be required for primary splenic tumors, large splenic cysts, or as part of the surgical staging for certain lymphomas. The surgical technique involves making either a midline or a left subcostal incision. The surgeon must carefully mobilize the spleen by dividing its peritoneal attachments—the gastrosplenic, splenorenal, splenocolic, and phrenicosplenic ligaments. Crucially, the splenic artery and vein must be identified at the hilum and ligated securely to prevent post-operative hemorrhage. Care must be taken to avoid injury to the tail of the pancreas, which lies in close proximity to the splenic hilum. Following the removal of the organ, the surgeon conducts a thorough search for accessory spleens, which, if left behind, could lead to a recurrence of the underlying hematologic condition. Post-splenectomy, patients enter a permanent immunocompromised state, requiring specific vaccinations and long-term vigilance regarding the risk of overwhelming post-splenectomy infection (OPSI).

Clinical Indications

  • Traumatic splenic rupture with hemodynamic instability
  • Refractory Immune Thrombocytopenic Purpura (ITP)
  • Hereditary Spherocytosis causing symptomatic anemia or gallstones
  • Symptomatic or massive splenomegaly
  • Hypersplenism causing severe cytopenias
  • Primary splenic malignancy or symptomatic benign tumors
  • Splenic abscess not responsive to percutaneous drainage
  • Splenic artery aneurysm or splenic infarction

Procedure Steps

  1. Patient is placed in the supine position and general anesthesia is administered.
  2. A midline laparotomy or left subcostal (Kocher) incision is performed to access the abdominal cavity.
  3. The abdomen is explored to identify the spleen and assess for any concurrent injuries or pathology.
  4. The spleen is mobilized by dividing the splenocolic, phrenicosplenic, and splenorenal ligaments.
  5. The short gastric vessels are identified and ligated to allow further mobilization and access to the hilum.
  6. The spleen is rotated medially to expose the posterior aspect of the splenic hilum.
  7. The splenic artery and splenic vein are individually identified, doubly ligated, and divided.
  8. The spleen is removed from the abdominal cavity and sent for pathological examination.
  9. The splenic bed and surrounding areas (tail of pancreas) are inspected for hemostasis and injury.
  10. The surgeon searches for accessory splenic tissue (splenules), particularly in cases of hematologic disease.
  11. The abdominal wall is closed in layers after a final count of instruments and sponges.

Coding Guidelines

  • CPT 38100 is designated as a 'separate procedure.' This means it should not be reported if it is performed as an integral part of a larger procedure (e.g., a total gastrectomy or distal pancreatectomy) unless it is performed for a separate and distinct clinical indication.
  • If the splenectomy is performed via a laparoscopic approach, use CPT 38120 instead of 38100.
  • If only a portion of the spleen is removed, report CPT 38101 (Partial splenectomy).
  • For repair of a ruptured spleen without total removal (splenorrhaphy), use CPT 38115.
  • Do not use 38100 for an incidental splenectomy performed during other abdominal surgery solely to facilitate exposure; it must be medically necessary.
  • Modifier 51 (Multiple Procedures) may be applicable if performed alongside other non-bundled procedures.

Associated ICD-10 Codes