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A cholecystoenterostomy, commonly known as a biliary bypass procedure, is a surgical intervention aimed at addressing biliary obstruction. This procedure is particularly relevant when there is a need to create a direct connection between the gallbladder and the small intestine, allowing for the drainage of bile. In the context of CPT® Code 47720, a direct choledochoenterostomy is specifically performed. The surgical approach begins with a midline abdominal incision, which provides access to the gallbladder and a segment of the small intestine. During the procedure, the gallbladder is carefully dissected, and a segment of the small intestine is mobilized and rotated to align with the gallbladder. A longitudinal incision is made in the small intestine, facilitating the anastomosis, or surgical connection, between the gallbladder and the small intestine. This connection is crucial as it enables bile to flow directly from the gallbladder into the small intestine, thereby bypassing any obstructions that may be present in the biliary tract. This procedure is essential for patients suffering from conditions that impede normal bile flow, ensuring that digestive processes can continue effectively.
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The cholecystoenterostomy procedure, as described by CPT® Code 47720, is indicated for patients experiencing biliary obstruction. This condition may arise from various underlying issues, including but not limited to:
The procedure for a cholecystoenterostomy, specifically under CPT® Code 47720, involves several critical steps to ensure successful anastomosis between the gallbladder and the small intestine. The surgical process begins with the patient being placed under general anesthesia. Following this, a midline abdominal incision is made to provide access to the abdominal cavity. Once the incision is made, the surgeon carefully exposes and mobilizes the gallbladder along with a segment of the small intestine. This mobilization is crucial as it allows for adequate manipulation of both structures during the anastomosis.
Next, the gallbladder is meticulously dissected from its surrounding tissues to prepare it for the connection with the small intestine. A segment of the small intestine is then rotated upwards to align with the gallbladder. A longitudinal incision is made in this segment of the small intestine, creating an opening that will facilitate the anastomosis. The surgeon then performs the anastomosis by suturing the gallbladder directly to the small intestine, establishing a new pathway for bile to drain directly into the intestinal tract. This step is vital as it bypasses any obstructions that may have been present in the biliary system, allowing for normal digestive function to resume.
After the completion of the cholecystoenterostomy, the surgical team will implement post-procedure care to ensure proper recovery. The surgical wound is thoroughly irrigated to prevent infection, and drains may be placed as necessary to facilitate the removal of any excess fluid or bile. The abdominal incision is then closed in layers to promote optimal healing. Patients can expect a recovery period that may vary based on individual health factors and the extent of the surgery. Monitoring for any signs of complications, such as infection or bile leakage, is essential during the post-operative phase. Follow-up appointments will be scheduled to assess the healing process and ensure that the anastomosis is functioning as intended.
| Short Descr | FUSE GALLBLADDER & BOWEL | Medium Descr | CHOLECYSTOENTEROSTOMY DIRECT | Long Descr | Cholecystoenterostomy; direct | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 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). | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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