Clinical Context
A 58-year-old female with a history of symptomatic cholelithiasis and recurrent biliary colic presents with new onset jaundice, right upper quadrant pain, and elevated bilirubin. Preoperative ultrasound and MRCP demonstrate gallstones and a common bile duct (CBD) obstruction that could not be cleared endoscopically or percutaneously. The surgical team schedules a cholecystectomy with intraoperative exploration of the CBD. During surgery, the surgeon performs an open or laparoscopic 47612 procedure: removal of the gallbladder with exploration of the common bile duct, and creation of a choledochojejunostomy (a biliary-enteric bypass) when the obstruction cannot be relieved by stone extraction.
Clinical workflow:
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Preoperative evaluation: history, physical, liver function tests, imaging (ultrasound, MRCP/CT), and anesthesia assessment.
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Intraoperative steps: induction of anesthesia; laparoscopic or open cholecystectomy; intraoperative cholangiography or choledochoscopy to evaluate the duct; attempted stone extraction or CBD exploration; when obstruction persists and cannot be cleared, construction of a biliary-enteric anastomosis (choledochojejunostomy) to restore bile flow.
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Immediate postoperative care: monitoring in PACU, pain control, assessment of bile leak or infection, serial labs for liver function.
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Follow-up: wound check, liver enzyme trend, nutritional counseling; potential ERCP or imaging if postoperative obstruction or complications arise.
Coding Specifications
| Modifier | Description | When to Use |
|---|
22 | Increased procedural services | Use when work required is substantially greater than usual (e.g., dense adhesions or complex reconstruction during 47612). |
| 62 | Two surgeons | Use when two surgeons collaborate, both performing distinct portions of the 47612 procedure.
| 66 | Surgical team | Use when a surgical team approach is documented for a complex biliary reconstruction.
| 52 | Reduced services | Use when the procedure is partially completed or limited compared with full 47612.
| 53 | Discontinued procedure | Use when the procedure is started but terminated for patient safety before completion.
| 78 | Unplanned return to OR by same surgeon | Use when a complication requires an immediate return to the operating room related to the original 47612.
| 79 | Unrelated procedure by same physician during postoperative period | (Not in provided list) Data not available in the input.
| 76 | Repeat procedure by same physician | (Not in provided list) Data not available in the input.
| 51 | Multiple procedures | Use when 47612 is performed with other distinct procedures during the same operative session.
| 53 | Reduced services | (Duplicate entry already listed) See above.
Associated provider taxonomies
| Taxonomy Code | Specialty | Notes |
|---|
| 207L00000X | General Surgery | General surgeons commonly perform cholecystectomy with CBD exploration and biliary-enteric anastomosis. |
| 2080P0206X | Colon & Rectal Surgery | Colorectal surgeons may assist in small bowel anastomosis (jejunal limb) during biliary-enteric reconstruction in complex cases.
| 208800000X | Transplant Surgery | Hepatobiliary/transplant surgeons perform complex biliary reconstructions when anatomy or prior surgery requires specialized expertise.
| 207L00000X | Surgical Oncology | Surgical oncologists may perform biliary bypass when malignancy causes obstruction.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
K80.20 | Calculus of gallbladder without cholecystitis without obstruction | Cholelithiasis prompting cholecystectomy; may be associated with CBD stones requiring exploration. |
| K80.50 | Calculus of bile duct without cholangitis or cholecystitis | Choledocholithiasis causing obstruction that may necessitate CBD exploration and bypass when clearance fails.
| K83.1 | Obstruction of bile duct | Direct indication for biliary-enteric bypass such as choledochojejunostomy performed in 47612.
| K81.1 | Acute cholecystitis | Indication for cholecystectomy; intraoperative CBD exploration may be performed if obstruction suspected.
| C24.0 | Malignant neoplasm of extrahepatic bile duct | Malignant obstruction of the bile duct that may require biliary bypass as performed in 47612.
| C23 | Malignant neoplasm of gallbladder | Tumor-related biliary obstruction or gallbladder disease leading to combined resection and bypass.
| K83.8 | Other specified diseases of bile duct | Covers inflammatory or stricturing conditions that may necessitate reconstruction or bypass.
| K82.9 | Disease of gallbladder, unspecified | General gallbladder disease prompting cholecystectomy with potential CBD exploration.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
47562 | Laparoscopic cholecystectomy with exploration of common bile duct, includes removal of calculi when performed | Often performed when CBD stones are suspected; may be attempted prior to conversion to 47612 if obstruction cannot be cleared. |
| 47563 | Laparoscopic cholecystectomy with exploration of common bile duct and removal of stone(s) by choledochotomy | Used when stones are removed laparoscopically through a choledochotomy during cholecystectomy; if stones cannot be cleared or reconstruction required, 47612 may be performed.
| 43840 | Jejunostomy, bypass, or anastomosis procedures (examples of small intestine anastomosis) | Codes for small bowel anastomosis techniques that conceptually relate to creation of a biliary-enteric anastomosis during 47612.
| 47570 | Laparoscopy, surgical; cholecystectomy — when converted to open | Represents conversion scenarios when laparoscopic approach is aborted and open 47612 may be completed.
| 43275 | Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and/or stone removal | Often attempted preoperatively to clear CBD obstruction; failure of ERCP can lead to proceeding with 47612.