Summary & Overview
CPT 47740: Cholecystoenterostomy (Biliary Bypass)
CPT code 47740 represents a surgical biliary bypass procedure (cholecystoenterostomy) in which an anastomosis is fashioned between the gallbladder and small intestine to restore bile flow when the native biliary tract is obstructed by tumor or other disease. This code is relevant nationally for hospitals and surgical practices managing malignant or benign biliary obstruction and has implications for operative planning, inpatient resource use, and episode-of-care payment.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the typical service type. The publication identifies common billing modifiers reported for surgical procedures and notes where input data is incomplete.
The analysis outlines benchmarks and considerations relevant to coding and billing for this complex operative service, summarizes potential payer coverage patterns, and highlights clinical situations that prompt use of this code. It also points to areas where additional documentation and coding detail are commonly required to support medical necessity and correct claim adjudication.
Billing Code Overview
CPT code 47740 describes a surgical procedure in which the surgeon creates an anastomosis between the gallbladder and the small intestine in an end-to-side (Y-shaped) fashion to permit free flow of bile when the biliary tree is obstructed by tumor or other disease. This procedure establishes an alternative pathway for bile drainage to relieve obstruction-related symptoms and complications.
Service Type: Surgical biliary bypass / cholecystoenterostomy
Typical Site of Service: Operating room / inpatient surgical setting, often performed under general anesthesia with postoperative inpatient care for monitoring and recovery.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old with malignant obstruction of the distal common bile duct from cholangiocarcinoma or metastatic pancreatic head tumor presenting with progressive jaundice, pruritus, dark urine, pale stools, and elevated bilirubin. Initial evaluation includes hepatic panel, abdominal imaging (ultrasound, CT, or MRCP) demonstrating biliary dilation and an obstructing lesion, and endoscopic retrograde cholangiopancreatography (ERCP) attempted when feasible. When endoscopic or percutaneous decompression is unsuccessful, contraindicated, or not durable, a surgical biliary-enteric bypass such as a cholecystojejunostomy (gallbladder-to-small-intestine anastomosis) is performed.
The clinical workflow: preoperative assessment and optimization, informed consent documented for palliative biliary bypass, general anesthesia, exploratory laparotomy or laparoscopy to assess anatomy and tumor extent, creation of an end-to-side or Roux-en-Y cholecystojejunostomy to allow bile drainage past the obstruction, intraoperative hemostasis and drainage as needed, postoperative monitoring for bile leak, infection, and hepatic function, pain control, and coordination with oncology for further care. Typical site of service is an inpatient operating room; this is a surgical procedure performed by general surgeons or surgical oncologists in a hospital setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Principal procedure | When this cholecystojejunostomy is the primary service performed during the encounter |