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The procedure described by CPT® Code 47715 involves the excision of a choledochal cyst, which is a congenital anomaly of the bile duct characterized by an abnormal cystic dilation of the biliary duct(s). This condition can lead to various complications, including biliary obstruction, cholangitis, and pancreatitis, necessitating surgical intervention. During the procedure, the surgeon makes a midline abdominal incision to gain access to the abdominal cavity, allowing for the exposure of the gallbladder and liver. Once the surgical field is prepared, the choledochal cyst is identified. The next step involves transecting the bile duct both above and below the cyst to remove the dilated portion effectively. After excising the cyst, the surgeon has the option to repair the bile duct by suturing the remaining segments together. Alternatively, if the situation requires, a Roux-en-Y hepaticojejunostomy or another reconstruction technique may be employed to ensure proper bile flow and prevent future complications. This procedure is critical for addressing the underlying issues associated with choledochal cysts and restoring normal biliary function.
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The excision of a choledochal cyst is indicated for patients presenting with specific symptoms or conditions associated with this congenital bile duct anomaly. The following indications are explicitly recognized for this procedure:
The procedure for excising a choledochal cyst involves several critical steps that ensure the effective removal of the cyst and restoration of normal biliary function. The following procedural steps are outlined:
Post-procedure care following the excision of a choledochal cyst is essential for ensuring a successful recovery. Patients are typically monitored for any signs of complications, such as infection or bile leakage. Pain management is provided as needed, and patients may be advised to follow a specific diet during the initial recovery phase. Follow-up appointments are crucial to assess the healing process and to ensure that the bile duct is functioning properly. Additional imaging studies may be performed to evaluate the surgical site and confirm the absence of any complications. Overall, the post-procedure phase is vital for the patient's recovery and long-term health outcomes.
| Short Descr | EXCISION OF BILE DUCT CYST | Medium Descr | EXCISION CHOLEDOCHAL CYST | Long Descr | Excision of choledochal cyst | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 99 - Other OR gastrointestinal therapeutic procedures |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| Pre-1990 | Added | Code added. |
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