General Surgery Coding Alert

Question: The surgeon treated a patient with a large choledochal cyst. The procedure involved an open cholecystectomy with en bloc excision of extrahepatic bile ducts (roux-en-Y reconstruction) with hepaticojejunostomy. What are the correct CPT and ICD-9 codes?

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Answer: The correct ICD-9 code will depend on whether the patient has an acquired or congenital choledochal cyst. You would expect to see the congenital cyst more commonly in pediatric patients. Assuming that the patient has an acquired cyst, the correct diagnosis code is 576.8 (Other specified disorders of the biliary tract). On the other hand, if your surgeon is treating a patient with a congenital choledochal cyst, you should report the diagnosis as 751.69 (Other anomalies of gallbladder, bile ducts, and liver).

CPT does not provide a specific code to describe excision of extrahepatic bile ducts, but you will find some codes that describe the subsequent reconstruction.

For the cholecystectomy, you should report 47600 (Cholecystectomy). If the duct excision represents significant extra work, you can append modifier 22 (Increased procedural services) to 47600. The surgeon's documentation should specify extra time and procedural steps that support using this modifier.

In addition to 47600, you should report the appropriate Roux-en-Y reconstruction code. Assuming that the surgeon anastomosed the intrahepatic ducts subsequent to removing the extrahepatic ducts, you should report 47785 (Anastomosis, Roux-en-Y of intrahepatic biliary ducts and gastrointestinal tract) for the repair.