Summary & Overview
CPT 47460: Incision of Sphincter of Oddi to Improve Duct Drainage
CPT code 47460 denotes an incision of the sphincter of Oddi at the ductal entry to the small intestine to improve biliary or pancreatic drainage. Nationally, this code captures a focused surgical intervention used to relieve ductal obstruction and manage complications of bile or pancreatic outflow. Accurate use of this code supports clinical documentation, appropriate facility and provider billing, and monitoring of procedure utilization for quality and cost management. Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, typical sites of service, and the role of this code in surgical billing workflows. The publication outlines common billing considerations, relevant modifiers and service-line alignment, and provides benchmarking context where available. It also highlights policy and documentation elements that affect coverage and claims adjudication at a national level. Data not available in the input is noted where applicable, and the report does not provide clinical recommendations but summarizes coding, billing, and policy-relevant information for administrators, coders, and clinician leaders.
Billing Code Overview
CPT code 47460 describes a surgical procedure in which the provider performs an incision of the sphincter of Oddi at the point where the bile or pancreatic duct enters the small intestine to improve ductal drainage. This procedure is a minor surgical intervention on the biliary/pancreatic sphincter intended to relieve obstruction and facilitate flow from the ductal system into the small intestine.
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Service type: Surgical procedure to incise the sphincter of Oddi to improve duct drainage
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Typical site of service: Hospital operating room or ambulatory surgical center where endoscopic or open biliary/pancreatic procedures are performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with recurrent biliary-type abdominal pain, jaundice, or cholangitis symptoms and imaging or endoscopic evaluation demonstrating impaired drainage at the ampulla of Vater due to sphincter of Oddi dysfunction, choledocholithiasis, or papillary stenosis. The clinical workflow begins with diagnostic evaluation — history, physical exam, liver function tests, abdominal ultrasound or MRCP, and often ERCP with cholangiography. During ERCP the endoscopist identifies a stenotic or dysfunctional sphincter and performs a sphincterotomy to incise the sphincter of Oddi to improve biliary or pancreatic drainage. The procedure is typically performed in an endoscopy suite or operating room with monitored anesthesia care or general anesthesia. Post-procedure monitoring includes observation for bleeding, pancreatitis, perforation, and infection with appropriate labs and clinical assessments prior to discharge or admission for observation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, distinct procedural service | Use when this sphincterotomy is the primary and unplanned procedure performed in a single session. |
22 | Increased procedural services |