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A Roux-en-Y cholecystoenterostomy, commonly referred to as a biliary bypass procedure, is a surgical intervention designed to alleviate biliary obstruction. This procedure is particularly indicated when there is a blockage in the bile ducts that prevents bile from flowing from the gallbladder into the small intestine. The term "Roux-en-Y" refers to the specific technique used to create a new pathway for bile drainage. In this procedure, an abdominal incision is made in the midline to access the gallbladder and a segment of the small intestine, specifically the jejunum. The gallbladder is carefully dissected to separate it from surrounding tissues. The jejunum is then mobilized and divided to create a Roux-en-Y limb, which is a Y-shaped configuration that facilitates the rerouting of bile. The distal end of the divided jejunum is anastomosed, or surgically connected, to the gallbladder, allowing bile to drain directly into the small intestine. In the case of CPT® Code 47741, the procedure is further enhanced by the inclusion of a gastroenterostomy, which involves creating a connection between the stomach and the small intestine. This additional step is performed to ensure that the digestive process remains efficient, particularly when the normal passage of food is disrupted. The surgical technique involves precise incisions and suturing to ensure proper healing and functionality of the newly created pathways for both bile and food.
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The Roux-en-Y cholecystoenterostomy with gastroenterostomy is indicated for patients experiencing biliary obstruction due to various conditions. The following are specific indications for this procedure:
The procedure for a Roux-en-Y cholecystoenterostomy with gastroenterostomy involves several critical steps, each designed to ensure the successful creation of new pathways for bile and food. The following outlines the procedural steps:
Post-procedure care for patients who have undergone a Roux-en-Y cholecystoenterostomy with gastroenterostomy includes monitoring for complications such as infection, leakage from the anastomosis, and ensuring proper recovery. Patients are typically observed in a hospital setting for a period to manage pain and assess the function of the new biliary and gastrointestinal pathways. Dietary modifications may be recommended to facilitate recovery, and follow-up appointments are essential to monitor the patient's progress and address any concerns that may arise during the healing process.
| Short Descr | FUSE GALLBLADDER & BOWEL | Medium Descr | CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM | Long Descr | Cholecystoenterostomy; Roux-en-Y with gastroenterostomy | 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). | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 1995-01-01 | Added | First appearance in code book in 1995. |
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