2025 CPT code 47999

Unlisted procedure, biliary tract.

CPT guidelines instruct that this code should only be used when no other appropriate specific procedure code exists.A cover letter must accompany the claim explaining the reason for using the unlisted code and providing comparisons to similar procedures.

Modifiers 51 (Multiple Procedures), 53 (Discontinued Procedure), 62 (Two Surgeons), 66 (Surgical Team), 78 (Unplanned Return to OR), 79 (Unrelated Procedure), AR (Physician services in a physician scarcity area), GY (Statutorily excluded item/service), and GZ (Item/service expected to be denied) may apply depending on the specific circumstances.

The medical necessity for the procedure must be clearly documented, explaining why the unlisted procedure was medically necessary and how it improved the patient's condition.This will often involve showing that existing coded procedures were inappropriate or inadequate.

The provider performs a procedure on the biliary tract that is not represented by any of the standard and active CPT® codes available.

IMPORTANT Refer to the iFrameAI product for similar, related, or alternate codes.

In simple words: This code is used when a doctor performs a procedure on the bile ducts or gallbladder that doesn't have its own specific billing code.The doctor must explain why they used this code instead of a more specific one and provide detailed medical records to support the billing.

This code, 47999, reports procedures on the biliary tract (biliary tree or system) lacking a specific CPT code.The biliary tract encompasses structures producing, storing, and transporting bile from the liver and gallbladder to the small intestine.Use only when no other appropriate CPT code exists, and submit detailed documentation justifying the use of an unlisted code, including a comparison to similar procedures.

Example 1: A surgeon performs a complex repair of a rare bile duct injury not covered by a specific CPT code.The surgeon documents the procedure in detail, comparing it to similar coded procedures., An interventional radiologist performs a novel minimally invasive technique to treat a biliary stricture, which is not described by existing codes.The procedure is meticulously documented and compared to established interventional radiology procedures., A gastroenterologist performs an endoscopic procedure to address a unique biliary abnormality not captured in existing CPT codes.The documentation includes procedural details and comparison to similar endoscopic biliary tract procedures.

Detailed operative notes, including the procedure performed, rationale for using unlisted code, comparison to similar procedures, and images if appropriate.Pre-operative and post-operative diagnoses, and any relevant imaging studies.

** Payment for unlisted procedures is determined on a case-by-case basis by the payer, based on the provided documentation.Thorough documentation is crucial for successful reimbursement.

  • Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
  • RVU: Refer to the iFrameAI product for RVU information.
  • Global Days : Refer to the iFrameAI product for global period information.
  • Payment Status: Active
  • Modifier TC rule: The application of a Technical Component (TC) modifier depends on the specific procedure and may require clarification from the iFrameAI product.
  • Fee Schedule : Refer to the iFrameAI product for historical fee schedule information.
  • Specialties:General Surgery, Gastroenterology, Interventional Radiology
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center
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