CPT 47720 Biliary-Enteric Anastomosis Reimbursement | OpenPayer

Summary & Overview

CPT 47720: Biliary-Enteric Anastomosis (Gallbladder to Small Intestine)

CPT code 47720 denotes a biliary-enteric surgical bypass connecting the gallbladder to the small intestine to provide bile drainage when the biliary tract is injured or obstructed by disease. This procedure is clinically important for managing malignant or benign biliary obstruction and for restoring bile flow when primary repair is not feasible. Nationally, the code is relevant to surgical departments, hospital billing operations, and payers managing high-acuity surgical claims. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 47720, guidance on expected sites of service, and a summary of typical payer coverage patterns and coding considerations. The publication also outlines common modifiers used with surgical procedures, benchmarking perspectives for claim adjudication, and policy considerations that affect prior authorization and medical necessity determinations. Information is presented to support revenue cycle teams, surgeons, and policy analysts in understanding how this CPT code fits into surgical care pathways and payer workflows at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare47720CPTbiliary-enteric anastomosissurgerybiliary bypassgallbladderinpatient surgeryoperative procedure

Billing Code Overview

CPT code 47720 describes a surgical procedure in which the gallbladder is directly anastomosed to the small intestine to establish drainage of bile. This operation is performed when injury, obstruction, or tumors of the biliary tract prevent normal biliary flow and require an internal bypass to relieve obstruction and allow bile drainage.

Service type: Surgical biliary bypass / biliary-enteric anastomosis
Typical site of service: Inpatient hospital operating room or other surgical setting where abdominal surgery is performed

Clinical & Coding Specifications

Clinical Context

A typical patient undergoing this procedure is an adult with obstructive biliary drainage failure due to malignant or traumatic injury of the extrahepatic biliary tree. For example, a 68-year-old patient with a cholangiocarcinoma causing distal bile duct obstruction presents with progressive jaundice, pruritus, and recurrent cholangitis despite endoscopic stenting attempts. Imaging (MRCP/CT) demonstrates unresectable tumor encasing the common bile duct with persistent proximal biliary dilation. After multidisciplinary review, the surgical team elects to perform an open cholecystoenterostomy to create a direct gallbladder-to-small-intestine anastomosis to bypass the obstructed bile duct and provide long-term drainage.

The clinical workflow begins with preoperative evaluation (labs, cross-sectional imaging, anesthesia assessment). Intraoperatively, the surgeon exposes the gallbladder and small bowel (typically jejunum or duodenum), constructs an anastomosis (e.g., cholecystojejunostomy), confirms bile flow, and secures hemostasis. Postoperatively, the patient is monitored for bile leak, infection, ileus, and return of bowel function, with follow-up imaging or bilirubin trends to confirm successful drainage. This procedure is typically performed when endoscopic or percutaneous drainage is not feasible or has failed, or when the pathology involves the extrahepatic biliary tract such that a bypass is clinically indicated.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

CPT 47760: Biliary-Enteric Bypass for Biliary Obstruction

CPT-47801-BILIARY-STENT-INSERTION

CPT 47801: Insertion of Biliary Stent

CPT-47740-CHOLECYSTOENTEROSTOMY-BILIARY-BYPASS

CPT 47740: Cholecystoenterostomy (Biliary Bypass)

CPT-47741-BILIARY-AND-GASTROENTERIC-BYPASS-ANASTOMOSIS

CPT 47741: Combined Biliary and Gastroenteric Bypass Anastomosis

CPT-47780-BILIARY-ENTERIC-ANASTOMOSIS-BYPASS

CPT 47780: Biliary-Enteric Anastomosis to Restore Bile Flow

CPT-47785-JEJUNUM-TO-INTRAHEPATIC-BILIARY-ANASTOMOSIS

CPT 47785: Jejunum to Intrahepatic Biliary Duct Anastomosis

CPT-47800-EXTRAHEPATIC-BILIARY-DUCT-RECONSTRUCTION

CPT 47800: Reconstruction of Extrahepatic Biliary Ducts

CPT-47765-BILIARY-ENTERIC-ANASTOMOSIS-SURGICAL-DRAINAGE

CPT 47765: Biliary-Enteric Anastomosis, Surgical Biliary Drainage

CPT-47721-BILIARY-AND-GASTRIC-BYPASS-ANASTOMOSIS

CPT 47721: Biliary and Gastric Bypass (Anastomoses)

CPT-47900-EXTRAHEPATIC-BILIARY-DUCT-REPAIR

CPT 47900: Repair of Extrahepatic Biliary Duct, Suture

Taxonomy Code	Specialty	Notes
207L00000X	General Surgery	Most common specialty performing open biliary-enteric bypass procedures.
207LP2900X	Surgical Oncology	Performs biliary bypass in patients with malignant biliary obstruction as part of oncologic care.
207RI0200X	Transplant Surgery	May perform complex biliary reconstructions and bypasses in select cases.
208000000X	Gastroenterology (Therapeutic Endoscopy)	Involved preoperatively for endoscopic stenting attempts and perioperative management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K83.1`	Obstruction of bile duct	Common indication for cholecystoenterostomy to bypass extrahepatic biliary obstruction.
`C24.0`	Malignant neoplasm of ampulla of Vater	Tumors in this region can obstruct bile flow and necessitate surgical bypass.
`C22.1`	Intrahepatic bile duct carcinoma	May cause biliary obstruction requiring bypass when extrahepatic drainage compromised.
`K80.5`	Calculus of bile duct without cholangitis	Impacting stones with persistent obstruction where bypass may be considered if other approaches fail.
`K83.0`	Cholestasis	Presents with impaired bile flow; surgical bypass can relieve cholestasis when obstructive.
`S36.3`	Injury of bile duct	Traumatic bile duct injury leading to leakage or obstruction may be managed with biliary-enteric anastomosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`47562`	Laparoscopic cholecystectomy, cholangiography when performed; and any biliary procedures performed at the same operation	May be performed prior to or instead of open bypass if anatomy and surgeon preference allow; represents less invasive management when appropriate.
`47563`	Laparoscopic cholecystectomy with cholangiography with exploration of common bile duct	Related when simultaneous exploration of the duct is attempted rather than bypass.
`47580`	Cholecystostomy, tube placement	Alternative drainage procedure; used when external percutaneous or tube drainage is chosen instead of internal biliary bypass.
`47060`	Excision of lesion of hepatic flexure; open (example hepatic procedures)	Represents intra-abdominal procedures that may be performed in the same operative session when multi-organ disease exists (use `51` multiple procedures).
`32551`	Tube thoracostomy, includes drainage and monitoring	Example of an additional procedure that may occur in complex surgical patients requiring postoperative chest drainage; included as potential concurrent procedure.

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