CPT 47765 Biliary-Enteric Anastomosis Reimbursement | OpenPayer

Summary & Overview

CPT 47765: Biliary-Enteric Anastomosis, Surgical Biliary Drainage

CPT code 47765 represents a surgical biliary-enteric anastomosis that creates an opening between the extrahepatic biliary ducts and the small intestine to establish biliary drainage. This procedure is used in clinical contexts where direct drainage from the biliary tree to the gut is required and has national relevance for surgical specialties, hospital billing, and payer coverage determinations.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The discussion covers how this code is used across inpatient and outpatient surgical settings, common billing modifiers, and implications for facility and professional claims. Readers will find a concise clinical context, guidance on typical sites of service, and an outline of what to expect in claims processing and payer interactions. Sections include benchmarking and coverage considerations where available and flag gaps when data is not present.

Data not available in the input for specific associated taxonomies, detailed ICD-10 mappings, payer-specific rates, and utilization benchmarks. The narrative remains nationally focused and provides a clear reference for clinicians, billing staff, and policy analysts seeking an overview of CPT code 47765 and its role in surgical biliary care.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare47765CPTbiliary-enteric anastomosissurgical-procedurebiliary-drainageoperative-carehospital-billing

Billing Code Overview

CPT code 47765 describes a surgical procedure that creates an opening (an anastomosis) between the extrahepatic biliary ducts and the small intestine. This procedure establishes biliary drainage by forming a direct connection from the ducts outside the liver to the intestinal tract.

Service type: Surgical biliary-enteric anastomosis
Typical site of service: Operating room, inpatient or outpatient surgical setting depending on clinical status and procedural approach

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with obstructive extrahepatic biliary disease such as malignant biliary obstruction from pancreatic head cancer, cholangiocarcinoma, or recurrent benign strictures after cholecystectomy. The patient presents with progressive jaundice, pruritus, clay-colored stools, and laboratory cholestasis (elevated bilirubin and alkaline phosphatase). Imaging (abdominal ultrasound, CT, or MRCP) demonstrates dilation of the extrahepatic bile ducts with a distal obstruction not amenable to endoscopic retrograde cholangiopancreatography (ERCP) stenting or when ERCP has failed.

In the clinical workflow the patient is evaluated by a hepatobiliary surgeon or interventional gastroenterologist. Preoperative assessment includes laboratory studies (liver panel, coagulation), cross-sectional imaging, and optimization of comorbid conditions. Under general anesthesia, the provider performs an open or laparoscopic choledochoenterostomy (creating an anastomosis between the extrahepatic bile duct and the small intestine, typically a Roux-en-Y hepaticojejunostomy) to reestablish biliary drainage. Postoperative care includes monitoring for bile leak, infection, and cholangitis; pain control; and follow-up liver function tests and imaging to confirm adequate drainage. Typical sites of service are the operating room in a hospital inpatient or ambulatory surgical center depending on acuity and complexity; the service type is a major surgical operative procedure involving biliary-enteric anastomosis.

Coding Specifications

Modifier	Description	When to Use
`00`	Not a real CMS modifier; placeholder (use payer-specific if required)

CPT 47741: Combined Biliary and Gastroenteric Bypass Anastomosis

CPT-47801-BILIARY-STENT-INSERTION

CPT 47801: Insertion of Biliary Stent

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-47780-BILIARY-ENTERIC-ANASTOMOSIS-BYPASS

CPT 47780: Biliary-Enteric Anastomosis to Restore Bile Flow

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

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

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

CPT 47760: Biliary-Enteric Bypass for Biliary Obstruction

CPT-47800-EXTRAHEPATIC-BILIARY-DUCT-RECONSTRUCTION

CPT 47800: Reconstruction of Extrahepatic Biliary Ducts

CPT-47900-EXTRAHEPATIC-BILIARY-DUCT-REPAIR

CPT 47900: Repair of Extrahepatic Biliary Duct, Suture

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

CPT 47785: Jejunum to Intrahepatic Biliary Duct Anastomosis

Taxonomy Code	Specialty	Notes
`207L00000X`	General Surgery	Surgeons who perform biliary-enteric anastomoses and hepatobiliary procedures.
`207RH0000X`	Hepatobiliary Surgery	Specialists focused on liver, bile duct, and pancreatic surgery; higher frequency for complex anastomoses.
`2084P0800X`	Gastroenterology	Interventional endoscopists who may perform ERCP and manage biliary obstruction; involved in pre- and post-procedure care.
`363L00000X`	Interventional Radiology	Performs percutaneous biliary drainage when endoscopic or surgical options are deferred; may be involved in multidisciplinary care.
`2086S0122X`	Surgical Oncology	Surgeons managing malignant biliary obstruction as part of oncologic resections and reconstructions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C24.0`	Malignant neoplasm of extrahepatic bile duct	Common indication when malignant obstruction of the extrahepatic ducts necessitates bypass.
`C25.0`	Malignant neoplasm of head of pancreas	Pancreatic head cancers frequently cause distal extrahepatic biliary obstruction requiring biliary-enteric drainage.
`K83.1`	Obstruction of bile duct	Direct clinical indication for creating an anastomosis to relieve obstruction.
`K83.0`	Cholangitis	Acute or chronic infection of the biliary tree; recurrent or complicated cholangitis may necessitate definitive surgical drainage.
`K55.9`	Vascular disorder of intestine, unspecified	Included when ischemic injury contributes to biliary-enteric complications (less common) — use cautiously.
`K91.89`	Other postprocedural complications and disorders of digestive system	Relevant when prior procedures produce strictures or leaks that require biliary-enteric reconstruction.
`K83.8`	Other specified diseases of biliary tract	Covers benign strictures, trauma, or other biliary conditions treated with biliary-enteric anastomosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`47562`	Laparoscopic cholecystectomy	May be performed concurrently if gallbladder pathology exists or to facilitate access during biliary surgery.
`47563`	Laparoscopic cholecystectomy with cholangiography	Used when intraoperative cholangiogram is indicated to define biliary anatomy prior to biliary-enteric anastomosis.
`47480`	Revision of biliary-enteric anastomosis	Performed when prior hepaticojejunostomy or choledochoenterostomy requires revision for stricture or leak.
`47540`	Lysis of adhesions (abdominal)	Frequently performed intraoperatively to gain access to the extrahepatic biliary tree prior to creating the anastomosis.
`47579`	Other biliary tract reconstructive procedures	Used for additional biliary reconstructive work not specifically described by other CPT codes; may be reported when adjunctive biliary reconstruction is required.
`47562`	Endoscopic or percutaneous biliary drainage (ERCP with stent placement is `43274`/`43271` series)	Preoperative or alternative drainage procedures are commonly performed; if ERCP fails, surgical biliary-enteric anastomosis is indicated.

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