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A Roux-en-Y cholecystoenterostomy, designated by CPT® Code 47740, is a surgical procedure primarily aimed at addressing biliary obstruction. This operation is a type of biliary bypass that facilitates the drainage of bile from the gallbladder directly into the small intestine, specifically the jejunum. The procedure is characterized by the construction of a Roux-en-Y limb, which is a surgical technique that creates a Y-shaped connection between the gallbladder and the small intestine. During the operation, an abdominal incision is made along the midline to access the gallbladder and a segment of the small intestine. The gallbladder is carefully dissected to prepare it for the anastomosis, which is the surgical connection between two structures. The jejunum, a part of the small intestine, is mobilized and divided to form the Roux-en-Y limb. The distal end of the divided jejunum is then anastomosed to the gallbladder, allowing bile to flow directly into the small intestine, while the proximal end is connected to the side of the jejunum. This procedure is particularly beneficial for patients who have experienced biliary obstruction, as it restores the normal flow of bile, which is essential for digestion and absorption of fats. It is important to note that this specific code does not include a gastroenterostomy, which is a different procedure that may be performed in conjunction with a Roux-en-Y cholecystoenterostomy under a different code (CPT® Code 47741).
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The Roux-en-Y cholecystoenterostomy (CPT® Code 47740) is indicated for patients experiencing biliary obstruction. This condition may arise from various causes, including but not limited to gallstones, tumors, or strictures that impede the normal flow of bile from the gallbladder to the small intestine. The procedure is performed to alleviate symptoms associated with biliary obstruction, such as jaundice, abdominal pain, and digestive issues.
The Roux-en-Y cholecystoenterostomy procedure involves several critical steps to ensure successful biliary bypass. Initially, an abdominal incision is made in the midline to provide access to the gallbladder and a segment of the small intestine. Once the incision is made, the gallbladder is carefully dissected from its surrounding tissues to expose it adequately for the subsequent steps. Following this, the jejunum, which is a part of the small intestine, is mobilized and divided. This division is essential for creating the Roux-en-Y limb. The next step involves constructing the Roux-en-Y limb, where the distal end of the divided jejunum is anastomosed to the gallbladder. This connection allows bile to drain directly from the gallbladder into the small intestine. The proximal end of the jejunum is then anastomosed to the side of the jejunum, completing the Y-shaped configuration. This configuration is crucial as it facilitates the proper flow of bile into the digestive tract, thereby alleviating the symptoms associated with biliary obstruction.
After the Roux-en-Y cholecystoenterostomy, patients typically require careful monitoring and post-operative care to ensure proper recovery. It is essential to observe for any signs of complications, such as infection or leakage at the anastomosis sites. Patients may be advised to follow a specific diet as they recover, gradually reintroducing solid foods as tolerated. Pain management is also a critical component of post-operative care, and healthcare providers may prescribe analgesics to help manage discomfort. Additionally, follow-up appointments are necessary to assess the surgical site and ensure that the bile is draining appropriately into the small intestine. The overall recovery period may vary depending on the individual patient's health status and the complexity of the procedure.
| Short Descr | FUSE GALLBLADDER & BOWEL | Medium Descr | CHOLECYSTOENTEROSTOMY ROUX-EN-Y | Long Descr | Cholecystoenterostomy; Roux-en-Y | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 99 - Other OR gastrointestinal therapeutic procedures |
| 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). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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