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A laparoscopic cholecystoenterostomy, also known as a laparoscopic biliary bypass procedure, is a minimally invasive surgical technique used to create a connection between the gallbladder and the small intestine. This procedure is typically indicated for patients who have conditions that obstruct the normal flow of bile, such as gallstones or tumors. The surgery is performed through small incisions in the abdomen, which reduces recovery time and minimizes postoperative pain compared to traditional open surgery. During the procedure, a trocar is inserted through a small incision at the navel, allowing for the introduction of a laparoscope—a thin tube equipped with a camera that provides visualization of the internal organs. The abdomen is inflated with carbon dioxide to create a working space for the surgeon. Additional incisions are made to insert surgical instruments necessary for the operation. The gallbladder is carefully visualized, and a loop of small bowel, typically from the jejunum, is brought into proximity with the gallbladder. Using a laparoscopic intracorporeal linear stapling device, the gallbladder and small bowel are anastomosed, or surgically connected, to facilitate the passage of bile directly into the intestine. After the anastomosis is completed, the stapler insertion sites are sutured closed, and the surgical instruments are removed before closing the portal incisions. This procedure is designed to restore bile flow and alleviate symptoms associated with biliary obstruction.
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The laparoscopic cholecystoenterostomy is indicated for specific conditions that necessitate the creation of a bypass for bile flow. These indications include:
The laparoscopic cholecystoenterostomy procedure involves several key steps that are performed with precision to ensure successful outcomes. The steps include:
Post-procedure care for patients who have undergone a laparoscopic cholecystoenterostomy typically involves monitoring for any complications, managing pain, and ensuring proper recovery. Patients may be advised to follow a specific diet as they recover, gradually reintroducing solid foods as tolerated. Follow-up appointments are essential to assess healing and the effectiveness of the anastomosis. Patients should be informed about signs of potential complications, such as infection or bile leakage, and instructed to seek medical attention if these occur. Overall, the minimally invasive nature of this procedure generally allows for a quicker recovery compared to traditional open surgery, with many patients able to return to normal activities within a few weeks.
| Short Descr | LAPARO CHOLECYSTOENTEROSTOMY | Medium Descr | LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY | Long Descr | Laparoscopy, surgical; cholecystoenterostomy | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 99 - Other OR gastrointestinal therapeutic procedures |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | GC | This service has been performed in part by a resident under the direction of a teaching physician | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2000-01-01 | Added | First appearance in code book in 2000. |
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