47460 Biliary sphincterotomy Medicare reimbursement rates in Maine

This code represents a surgeon’s operative incision of the biliary sphincter, the outlet where bile passes into the intestine. It is distinct from an endoscopic sphincterotomy performed through an ERCP scope. A general or hepatobiliary surgeon may perform the surgical procedure in a hospital operating room when operative access to the sphincter is needed, for example, in treating an obstruction at the distal bile duct outlet.

Report the code when the operative record supports a surgical sphincter incision, rather than only a bile duct incision or an endoscopic procedure. Documentation should identify the operative approach, the sphincter treated, and the reason for the incision. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.