47120

Hepatectomy, resection of liver; partial lobectomy

CPT 47120 describes the surgical removal of a portion of a liver lobe, a procedure technically known as a partial lobectomy or segmental resection. This open surgical procedure is typically performed to manage localized pathology within the hepatic parenchyma. The liver is an anatomically complex organ organized into eight segments based on its vascular inflow, outflow, and biliary drainage, according to the Couinaud classification. A partial lobectomy involves the resection of one or more of these segments without removing the entire right or left lobe. The surgeon begins by performing a laparotomy, often using a subcostal (Kocher) or midline incision to gain adequate exposure of the upper abdomen. The liver is then mobilized by dividing its ligamentous attachments, such as the falciform, coronary, and triangular ligaments. Intraoperative ultrasound is frequently utilized to identify the precise location of the lesion and its relationship to major intrahepatic vessels like the portal veins and hepatic veins. Once the margins are defined, the surgeon proceeds with parenchymal transection. This is achieved using various techniques, including the clamp-crush method, ultrasonic aspirators (CUSA), or advanced bipolar cautery. Throughout the transection, small bile ducts and blood vessels are meticulously ligated or clipped to prevent postoperative hemorrhage or bile leaks. The specimen is removed, and the resection bed is inspected for hemostasis and biliostasis. Topical hemostatic agents may be applied before the abdominal wall is closed in layers.

Clinical Indications

  • Hepatocellular carcinoma (HCC) localized to specific segments
  • Metastatic liver disease, most commonly from colorectal primary
  • Benign liver tumors such as symptomatic hemangiomas or hepatic adenomas
  • Intrahepatic cholangiocarcinoma
  • Focal nodular hyperplasia (FNH) causing symptoms or diagnostic uncertainty
  • Symptomatic or enlarging hepatic cysts
  • Localized liver abscesses refractory to percutaneous drainage
  • Traumatic liver injury with devitalized tissue requiring debridement

Procedure Steps

  1. Induction of general anesthesia and placement of hemodynamic monitoring.
  2. Performance of a right subcostal or midline laparotomy incision.
  3. Exploration of the abdominal cavity to rule out extrahepatic disease or carcinomatosis.
  4. Mobilization of the liver by dividing the falciform and triangular ligaments.
  5. Utilization of intraoperative ultrasound to map the tumor and vascular structures.
  6. Isolation of the segmental portal triad structures if an anatomical resection is planned.
  7. Transection of the liver parenchyma using ultrasonic dissection or the crush-and-clamp technique.
  8. Ligation or clipping of intrahepatic bile ducts and blood vessels encountered during transection.
  9. Removal of the resected liver segment and submission for pathological examination.
  10. Verification of hemostasis and biliostasis on the raw surface of the remaining liver.
  11. Placement of abdominal drains if clinically indicated.
  12. Layered closure of the laparotomy incision.

Coding Guidelines

  • Code 47120 is used for an open partial lobectomy; for laparoscopic resection, see CPT codes 47370-47371 or 47399.
  • Distinguish 47120 (partial) from 47122 (trisegmentectomy) and 47125 (total left lobectomy) or 47130 (total right lobectomy).
  • Intraoperative ultrasound (e.g., 76998) may be reported separately depending on payer policy and documentation.
  • Cholecystectomy (47600) is often considered bundled if performed solely to gain access to the surgical site; check NCCI edits.
  • Control of intraoperative hemorrhage is inherent to the procedure and not reported separately.
  • If a biopsy of a different lobe is performed, modifier 59 or XS may be required.

Associated ICD-10 Codes