Summary & Overview
CPT 47425: Common Bile Duct Exploration and Sphincterotomy
Headline: CPT code 47425 defines open exploration and incision of the common bile duct, a surgical intervention used to diagnose and relieve biliary obstruction.
Lead: CPT code 47425 represents an operative procedure to identify and incise the common bile duct — including removal of stones, placement of drainage tubes, or incision of the sphincter of Oddi to improve biliary drainage. This code reflects a definitive surgical approach to biliary obstruction and related pathology and remains clinically important for acute and complex biliary disease.
Why it matters: Nationally, procedures coded with CPT code 47425 are central to managing obstructive biliary conditions that may not be amenable to endoscopic treatment. Use of this code impacts surgical case mix, hospital resource utilization, and postoperative care pathways.
Key payers: This analysis covers coverage and billing considerations for Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication outlines the clinical context for CPT code 47425, expected sites of service, typical services included in the procedure, and billing patterns. It also summarizes available national benchmarks and recent policy updates where applicable. Data not available in the input will be noted as such.
Billing Code Overview
CPT code 47425 describes an open surgical procedure on the common bile duct. In this procedure the provider identifies and incises the common bile duct to examine the structure, remove an obstructing stone, place a drainage tube, or otherwise restore biliary flow. The description also includes incision of the sphincter of Oddi at the ductal-enteric junction when performed to improve drainage.
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Service type: Open biliary surgery involving common bile duct exploration and/or sphincterotomy
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Typical site of service: Hospital operating room or ambulatory surgical center for invasive biliary procedures
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55-year-old individual presenting with right upper quadrant abdominal pain, jaundice, fever, and abnormal liver function tests suggestive of obstructive biliary disease. Imaging (ultrasound, CT, or MRCP) demonstrates choledocholithiasis or dilation of the common bile duct. The surgical team schedules an open or laparoscopic common bile duct exploration with choledochotomy and possible T-tube placement or sphincteroplasty. Intraoperative steps include identification and incision of the common bile duct, extraction of stones or debris, assessment of the distal biliary sphincter (sphincter of Oddi), and placement of a drainage tube when indicated. Typical workflow involves preoperative consent and optimization, general anesthesia, intraoperative cholangiography as needed, stone removal or sphincter incision, tube placement if required, postoperative monitoring for bile leak or infection, and discharge planning with follow-up for tube removal if a T-tube is placed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure requires substantially greater work or complexity than typical (document rationale). |
23 | Unusual anesthesia |