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CPT 47741: Combined Biliary and Gastroenteric Bypass Anastomosis

CPT code 47741 identifies a complex surgical procedure that establishes both a biliary-enteric anastomosis (gallbladder to small intestine) and a gastroenterostomy to restore bile drainage and gastric emptying when standard tumor resection is not feasible. The code is clinically significant for managing obstructive complications of advanced pancreatic or periampullary disease where palliative restoration of biliary and gastric continuity is required. Nationally, this procedure impacts hospital surgical service lines, inpatient resource utilization, and reimbursement for complex hepatobiliary operations.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for why the procedure is performed, the typical inpatient setting for delivery, and the types of quality and coding considerations associated with combined biliary and gastric bypass surgery. The publication also outlines expected documentation elements, common modifier groupings (Data not available in the input), and where this service sits within surgical gastroenterology and hepatobiliary case mixes.

This summary prepares clinicians, coders, and policy analysts to understand the clinical indication, typical site of service, and payer landscape for CPT code 47741, and points to areas where more detailed payment benchmarking and policy updates would be relevant.

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Billing Code Overview

CPT code 47741 describes a combined surgical bypass procedure that creates an anastomosis between the gallbladder and the small intestine (an end-to-side, Y-shaped biliary-enteric anastomosis) while also constructing a gastroenterostomy to restore gastric and biliary drainage. The procedure is typically performed to reestablish gastric emptying and bile flow when standard resections are not possible, such as with inoperable pancreatic malignancy.

Service type: Complex open or potentially minimally invasive surgical biliary and gastric bypass (combined biliary-enteric and gastroenteric anastomosis)
Typical site of service: Inpatient hospital operating room with postoperative inpatient recovery

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CPT 47741: Combined Biliary and Gastroenteric Bypass Anastomosis

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Billing Code Overview

Service type: Complex open or potentially minimally invasive surgical biliary and gastric bypass (combined biliary-enteric and gastroenteric anastomosis)
Typical site of service: Inpatient hospital operating room with postoperative inpatient recovery

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with inoperable pancreatic head adenocarcinoma develops both obstructive jaundice from malignant biliary obstruction and symptomatic gastric outlet obstruction due to tumor involvement of the distal stomach and proximal duodenum. The surgical team elects to perform a combined biliary-enteric and gastric bypass procedure to re-establish bile drainage and restore enteric continuity. In the operating room under general anesthesia, the surgeon performs a cholecystoenterostomy (creating an end-to-side or Y-shaped anastomosis between the gallbladder and a jejunal limb) and a gastrojejunostomy (creating a new connection between the stomach and the small intestine). The goals are palliation of biliary obstruction, prevention of cholangitis and progressive jaundice, and relief of gastric outlet obstruction to allow oral intake.

Preoperative workflow includes cross-sectional imaging (CT or MRI) confirming unresectable disease and level of obstruction, laboratory evaluation including liver function tests and coagulation profile, and multidisciplinary review. Intraoperative steps include exploration, identification of viable gallbladder and gastric/jejunal segments, creation of the anastomoses (end-to-side/Y-shaped biliary-enteric and gastrojejunostomy), hemostasis, and abdominal closure. Postoperative care focuses on pain control, monitoring for bile leak or anastomotic complications, gradual reintroduction of enteral intake, and coordination with oncology and palliative care for ongoing cancer management.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal component of the service	When the service is performed under usual circumstances without unusual services or complications
`22`	Increased procedural services	When work substantially exceeds typical due to complexity (extensive adhesiolysis, unexpected anatomy)
`23`	Unusual anesthesia	When general anesthesia is not planned but required because of patient condition
`26`	Professional component	When only the surgeon’s professional component is reported separate from facility billing (rare for operative procedures)
`50`	Bilateral procedure	When a procedure is performed bilaterally (not typically applicable but listed if bilateral biliary procedures occur)
`51`	Multiple procedures	When other distinct procedures are performed during the same operative session in addition to the bypass
`52`	Reduced services	When the procedure is partially reduced or not completed as planned
`53`	Discontinued procedure	When the procedure is started but aborted due to unforeseen circumstances
`62`	Two surgeons	When two surgeons work together as primary surgeons for distinct operative work
`78`	Return to OR for related procedure during postoperative period	When a reoperation for anastomotic leak or obstruction occurs during the global period
`79`	Unrelated procedure during postoperative period	When an unrelated procedure is performed during the global period (not in provided modifier list but commonly relevant)
`81`	Minimum assistant surgeon	When a physician assistant or surgeon assistant performs minimal assisting functions (applicability depends on payer rules)

Taxonomy Code	Specialty	Notes
207P00000X	General Surgery	Primary specialty performing biliary-enteric and gastrojejunostomy procedures
208600000X	Surgical Oncology	Often involved when procedure is palliative for malignant disease
207T00000X	Gastrointestinal Surgery	Subspecialty focusing on upper GI and biliary operations
363A00000X	Anesthesiology	Provides intraoperative general anesthesia and perioperative care
207L00000X	Hepatobiliary Surgery (if available)	Surgeons with focused expertise in biliary tract procedures

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C25.0`	Malignant neoplasm of head of pancreas	Common cause of distal biliary obstruction and gastric outlet obstruction prompting bypass
`C25.9`	Malignant neoplasm of pancreas, unspecified	Malignancy causing biliary and gastric outlet obstruction when site is not further specified
`K83.1`	Obstruction of bile duct	Direct indication for biliary bypass or drainage to relieve obstructive jaundice
`K31.6`	Gastroparesis (nonobstructive)	Included when severe gastric emptying issues require bypass—less common but relevant for gastric bypass indications
`K56.6`	Other and unspecified intestinal obstruction	May be used when gastric outlet obstruction is coded under intestinal obstruction categories

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43846`	Gastric bypass, gastrojejunostomy for obstruction (open or laparoscopic, code varies)	Codes that describe creation of a gastrojejunostomy; may be reported when an isolated gastrojejunostomy is performed or when component coding is required
`47060`	Cholecystostomy, percutaneous, with tube placement	A nonoperative biliary drainage option that may be performed preoperatively or as an alternative to surgical cholecystoenterostomy
`47562`	Laparoscopic cholecystectomy	May be performed if cholecystectomy is required instead of cholecystoenterostomy during the same operation
`49255`	Lysis of adhesions, abdomen/pelvis (open or laparoscopic)	Frequently performed adjunctively when extensive adhesions are encountered prior to creating the anastomoses
`74320`	Percutaneous transhepatic cholangiography (PCT) or biliary drainage (radiologic)	Diagnostic and therapeutic radiologic biliary procedures that can be alternatives or adjuncts in multidisciplinary care

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

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

CPT 47721: Biliary and Gastric Bypass (Anastomoses)

CPT-47740-CHOLECYSTOENTEROSTOMY-BILIARY-BYPASS

CPT 47740: Cholecystoenterostomy (Biliary Bypass)

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

CPT 47760: Biliary-Enteric Bypass for Biliary Obstruction

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

CPT 47765: Biliary-Enteric Anastomosis, Surgical Biliary Drainage

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-47801-BILIARY-STENT-INSERTION

CPT 47801: Insertion of Biliary Stent

CPT-47900-EXTRAHEPATIC-BILIARY-DUCT-REPAIR

CPT 47900: Repair of Extrahepatic Biliary Duct, Suture

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Normal component of the service	When the service is performed under usual circumstances without unusual services or complications
`22`	Increased procedural services	When work substantially exceeds typical due to complexity (extensive adhesiolysis, unexpected anatomy)
`23`	Unusual anesthesia	When general anesthesia is not planned but required because of patient condition
`26`	Professional component	When only the surgeon’s professional component is reported separate from facility billing (rare for operative procedures)
`50`	Bilateral procedure	When a procedure is performed bilaterally (not typically applicable but listed if bilateral biliary procedures occur)
`51`	Multiple procedures	When other distinct procedures are performed during the same operative session in addition to the bypass
`52`	Reduced services	When the procedure is partially reduced or not completed as planned
`53`	Discontinued procedure	When the procedure is started but aborted due to unforeseen circumstances
`62`	Two surgeons	When two surgeons work together as primary surgeons for distinct operative work
`78`	Return to OR for related procedure during postoperative period	When a reoperation for anastomotic leak or obstruction occurs during the global period
`79`	Unrelated procedure during postoperative period	When an unrelated procedure is performed during the global period (not in provided modifier list but commonly relevant)
`81`	Minimum assistant surgeon	When a physician assistant or surgeon assistant performs minimal assisting functions (applicability depends on payer rules)

Taxonomy Code	Specialty	Notes
207P00000X	General Surgery	Primary specialty performing biliary-enteric and gastrojejunostomy procedures
208600000X	Surgical Oncology	Often involved when procedure is palliative for malignant disease
207T00000X	Gastrointestinal Surgery	Subspecialty focusing on upper GI and biliary operations
363A00000X	Anesthesiology	Provides intraoperative general anesthesia and perioperative care
207L00000X	Hepatobiliary Surgery (if available)	Surgeons with focused expertise in biliary tract procedures

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C25.0`	Malignant neoplasm of head of pancreas	Common cause of distal biliary obstruction and gastric outlet obstruction prompting bypass
`C25.9`	Malignant neoplasm of pancreas, unspecified	Malignancy causing biliary and gastric outlet obstruction when site is not further specified
`K83.1`	Obstruction of bile duct	Direct indication for biliary bypass or drainage to relieve obstructive jaundice
`K31.6`	Gastroparesis (nonobstructive)	Included when severe gastric emptying issues require bypass—less common but relevant for gastric bypass indications
`K56.6`	Other and unspecified intestinal obstruction	May be used when gastric outlet obstruction is coded under intestinal obstruction categories

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43846`	Gastric bypass, gastrojejunostomy for obstruction (open or laparoscopic, code varies)	Codes that describe creation of a gastrojejunostomy; may be reported when an isolated gastrojejunostomy is performed or when component coding is required
`47060`	Cholecystostomy, percutaneous, with tube placement	A nonoperative biliary drainage option that may be performed preoperatively or as an alternative to surgical cholecystoenterostomy
`47562`	Laparoscopic cholecystectomy	May be performed if cholecystectomy is required instead of cholecystoenterostomy during the same operation
`49255`	Lysis of adhesions, abdomen/pelvis (open or laparoscopic)	Frequently performed adjunctively when extensive adhesions are encountered prior to creating the anastomoses
`74320`	Percutaneous transhepatic cholangiography (PCT) or biliary drainage (radiologic)	Diagnostic and therapeutic radiologic biliary procedures that can be alternatives or adjuncts in multidisciplinary care

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

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

CPT 47721: Biliary and Gastric Bypass (Anastomoses)

CPT-47740-CHOLECYSTOENTEROSTOMY-BILIARY-BYPASS

CPT 47740: Cholecystoenterostomy (Biliary Bypass)

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

CPT 47760: Biliary-Enteric Bypass for Biliary Obstruction

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

CPT 47765: Biliary-Enteric Anastomosis, Surgical Biliary Drainage

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-47801-BILIARY-STENT-INSERTION

CPT 47801: Insertion of Biliary Stent

CPT-47900-EXTRAHEPATIC-BILIARY-DUCT-REPAIR

CPT 47900: Repair of Extrahepatic Biliary Duct, Suture

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 47741: Combined Biliary and Gastroenteric Bypass Anastomosis

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Billing Code Overview

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CPT 47741: Combined Biliary and Gastroenteric Bypass Anastomosis

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 47741: Combined Biliary and Gastroenteric Bypass Anastomosis

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Billing Code Overview

CPT 47741: Combined Biliary and Gastroenteric Bypass Anastomosis

Sign up for cpt 47741 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical service does CPT 47741 represent and where is it usually performed?

What clinical context and perioperative workflow are associated with this procedure?

Which CPT modifiers are commonly relevant to reporting CPT 47741?

What other CPT codes are related to or potentially reported alongside CPT 47741?

Which diagnoses support medical necessity for reporting CPT 47741?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical service does CPT 47741 represent and where is it usually performed?

What clinical context and perioperative workflow are associated with this procedure?

Which CPT modifiers are commonly relevant to reporting CPT 47741?

What other CPT codes are related to or potentially reported alongside CPT 47741?

Which diagnoses support medical necessity for reporting CPT 47741?

References