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    v1.0.30
    OpenPayerBilling CodesRepair Procedures on the Biliary TractCPT cpt-47721-biliary-and-gastric-bypass-anastomosis
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    CPT 47721: Cholecystoenterostomy with Gastrojejunostomy

    Medicare pays $1285 on average nationally for this procedure.

    CPT code 47721 describes a combined cholecystoenterostomy with gastrojejunostomy, a surgical procedure that creates a new connection between the gallbladder and small intestine to restore biliary drainage while simultaneously creating a bypass from the stomach to the small intestine to restore gastric emptying; this is typically performed as an open or laparoscopic palliative gastrointestinal and biliary bypass for conditions such as inoperable pancreatic malignancy, and the service type is surgical: biliary and gastric bypass, typically performed in an inpatient hospital operating room or specialized surgical suite.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 65-year-old with advanced, unresectable pancreatic head adenocarcinoma causing both gastric outlet obstruction and malignant biliary obstruction. The patient presents with progressive nausea, vomiting, weight loss, obstructive jaundice, pruritus, and elevated bilirubin. Imaging (CT or MRI) demonstrates a pancreatic mass compressing the distal common bile duct and duodenum. Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is attempted but is unsuccessful or not feasible due to tumor anatomy. The surgical team elects to perform a concurrent gastrojejunostomy and cholecystojejunostomy (Roux-en-Y or loop configuration) to restore gastric emptying and provide biliary drainage.

    Preoperative workflow includes medical optimization, anesthesia evaluation, informed consent discussing palliative goals, and appropriate imaging review. Intraoperative steps include exploratory laparotomy or laparoscopy conversion, assessment of tumor operability, creation of an anastomosis between the gallbladder and jejunum for biliary drainage, and creation of a gastrojejunostomy to bypass the obstructed stomach outlet. Postoperative care involves monitoring for anastomotic leak, infection, bile leak, return of bowel function, and pain control, with coordination between surgical, oncology, and palliative care teams for ongoing management.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    47562Laparoscopic cholecystectomyMay be performed prior to or instead of cholecystoenteric anastomosis when gallbladder removal is indicated or when laparoscopic access is used
    43644Laparoscopy, surgical; gastrojejunostomy, with or without vagotomyLaparoscopic approach to create gastric bypass; an alternative technique to open gastrojejunostomy portion of the procedure
    43846Gastric bypass for morbid obesity, Roux-en-Y, distal or revisionShares technical steps for creation of gastrojejunostomy and roux limb construction; not for obesity indication but similar anastomotic techniques may be used
    47570Common bile duct exploration, with removal of obstructionMay be performed if common bile duct stones or need for exploration occurs in conjunction with biliary drainage procedures
    32440Thoracotomy; for pulmonary decortication (example of unrelated thoracic code)Data not available in the input.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207P00000X
    207K00000X
    208000000X
    3747P1801X
    363LA2100X
    364SC2300X
    1835X0200X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    C16.9Malignant neoplasm of stomach, unspecified
    C17.9Malignant neoplasm of small intestine, unspecified
    C24.1Malignant neoplasm of ampulla of Vater
    C25.1Malignant neoplasm of body of pancreas
    C25.2Malignant neoplasm of tail of pancreas
    C25.9Malignant neoplasm of pancreas, unspecified
    C78.7Secondary malignant neoplasm of liver and intrahepatic bile duct
    E86.0Dehydration
    I85.00Esophageal varices without bleeding
    I85.01Esophageal varices with bleeding

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-47720-BILIARY-ENTERIC-ANASTOMOSIS-GALLBLADDER-TO-SMALL-INTESTINE

    CPT 47720: Cholecystojejunostomy for Biliary Drainage

    CPT-47740-CHOLECYSTOENTEROSTOMY-BILIARY-BYPASS

    CPT 47740: Cholecystoenterostomy (Biliary Bypass)

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

    CPT 47741: Biliary Enteric and Gastrojejunostomy Bypass

    CPT-47760-BILIARY-ENTERIC-BYPASS-FOR-BILIARY-OBSTRUCTION

    CPT 47760: Biliary-enteric Anastomosis for Obstructive Biliary Disease

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

    CPT 47765: Bilioenteric Anastomosis Between Extrahepatic Bile Ducts and Small Intestine

    CPT-47780-BILIARY-ENTERIC-ANASTOMOSIS-BYPASS

    CPT 47780: Biliary‑enteric Anastomosis (Hepaticojejunostomy)

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

    CPT 47785: Hepatic Intrahepatic Bilioenteric Anastomosis to Jejunum

    CPT-47800-EXTRAHEPATIC-BILIARY-DUCT-RECONSTRUCTION

    CPT 47800: Reconstruction of Extrahepatic Biliary Ducts by Anastomosis

    CPT-47801-BILIARY-STENT-INSERTION

    CPT 47801: Bile Duct Stent Insertion

    CPT-47900-EXTRAHEPATIC-BILIARY-DUCT-REPAIR

    CPT 47900: Repair of Extrahepatic Biliary Duct

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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