Laparoscopic lysis of adhesions cpt code

STEP 1: Using the table below, select the appropriate codes from each column in the respective order. Finding the appropriate ICD-10-PCS Code1 STEP 2: Combine the code in the respective order from left to right. This is your ICD-10-PCS Code. For example, the code for Introduction of Adhesion Barrier into Pleural Cavity, Open Approach (3E0L05Z ...

Laparoscopic lysis of adhesions cpt code. For example: CPT code 58660, Lysis of adhesions, is not to be reported separately when done in conjunction with CPT code 58661, Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) HCPCS Code Code Description In-Office In-Facility Hospital Outpatient Payment ASC Payment

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Nov 5, 2008 ... WHAT TO DO: Do...Report a laparoscopic lysis code (44180, 58660) if the following are documented in the medical record: Adhesions are multiple ...If the surgeon spends significant time performing lysis of adhesions, but you cannot find a CPT® code specific to the anatomic location, you can account for the additional work … See moreA laparoscope – a thin tube with a camera on the end – is inserted into the abdomen, usually at the sight of your navel, through a small incision. Additional incisions will be made in your abdomen. Air will be used in the abdomen to create more space between your abdominal wall and internal organs. The surgeon will use the laparoscope and ...CPT® includes a number of codes dedicated to lysis of adhesions (categorized by location). For example: Tubes and ovaries, 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) or 58740 Lysis of adhesions (salpingolysis, ovariolysis)SNOMED code: 708614008: name: Laparoscopic lysis of adhesion of peritoneum: status: active: date introduced: 2015-07-31: fully specified name(s) Laparoscopic lysis of adhesion of peritoneum (procedure) synonyms: Laparoscopic lysis of peritoneal adhesion; Laparoscopic lysis of adhesion of peritoneum; attributes …

52204 (path cystourethroscopy-biopsy) blepharoplasty of the upper eyelid. 15822 (path blepharoplasty, upper eyelid) (no modifier as upper eyelid is in the description) insertion of temporary prostatic urethral stent. 53855 (path: prostate-urethra-stent insertion, temporary) reference codes 31360-31368 for laryngectomy; what is the correct code ...If laparoscopic lysis of adhesions is the only procedure performed can we code 49329 without the documentation of"extensive". Does that rule only appy when...Laparoscopy, surgical, with lysis of adhesions (salpingolysis, ovariolysis) (separate procedures)is there a cpt code for lysis of adhesion in male? my doctor billed 58660 but this is for female? should use an unlisted i did not see any. help . C. colorectal surgeon Guest. ... laparoscopic lysis of adhesions along with nephroureterectomy . A. ajb1986 Guest. Messages 30 Best answers 0. Apr 17, 2015 Lysis of adhesions may be done using a method called laparoscopy. This method uses a few small cuts (incisions) in your belly (abdomen). Or it may be done as open surgery, with a large cut. You are given medicine (general anesthesia). This puts you into a deep sleep through the procedure. For a laparoscopy, the healthcare provider makes 2 to 4 ... Mar 30, 2011 · There was an obstruction of the distal small bowel from an internal hernia from adhesions. These bands were lysed, all of the bowel was mobilized from the ligament of Treitz to the ileocecal junction. The prior anastomosis was noted, was patent and the obstruction was just distal to this. We assured that the bowel was healthy.

045430-220109 2022 Adhesions Reimbursement Guide. 2023 Adhesions Reimbursement Guide. The information contained in this documentis provided for informational purposes only and representsno statement, promise, or guarantee by Ethicon concerning levels of reimbursement, payment,or charge. Similarly, all CPT, ICD-10 and HCPCS codes are supplied ... In advanced stages of the disease the intraabdominal inflammation and scarring may make the procedure ineffective and a more radical approach is indicated. When addressing to a surgeon for the cure of endometriosis, the initial step is laparoscopic confirmation of suspected diagnosis with or without biopsy. Aug 21, 2014 · Laparoscopic-to-open Surgery Coding. When a procedure begins by laparoscopic approach, but for any reason must be converted (and completed) by open approach, you should report only the open approach. As described in chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual: This procedure is used to treat abdominal and chronic pelvic pain caused by adhesions. Adhesions are scars that form within the body, typically after surgery, as part of the healing process. Physical and Occupational Therapy. Subscribe to Our Patient Newsletter.CPT 44180 is a code used to describe a laparoscopic procedure called enterolysis. This procedure involves the surgical removal of intestinal adhesions, which are fibrous bands that form between tissues and organs, often as a result of previous surgery or injury. Enterolysis is performed using minimally invasive techniques, with small incisions ...

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If the uterus was > 250gm, the correct code would be 58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s). Since the op note specified over an hour (more specific like 75 minutes, etc would be better, but it is at least an hour) for lysis of adhesions, that to me justifies -22.58660 (Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)) 58740 ( Lysis of adhesions (salpingolysis, ovariolysis) ). Establishing where the surgeon lysed the adhesions is the first step to determine which code to select:Lysis of adhesions should not be reported together with any other surgical laparoscopic procedure. There are other rules out there and I can tell you some will code the lysis other's won't. I haven't had any luck getting lysis paid so I quit coding unless it was by itself, and started adding the 22 modifier if extensive, leaving it as inclusive ...CPT 58660 narrates the laparoscopy with lysis of fallopian tubes and ovaries adhesions; It is a surgical technique and counts as a separate operation. The global period is 90 – days. CPT 58740 narrates the lysis of adhesions of fallopian tubes or ovaries. The global period comprises 90 – days.You can report this procedure as 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [eg, ovarian cyst] [single or multiple]). Link this to tubo-ovarian abscess ICD-10 code N70.93 (Salpingitis and oophoritis, unspecified). You may not report lysis of adhesions separately with these codes.Dec 1, 2002 · Answer: You should always list the most extensive procedure first on the claim form. In this case, the laparo-scopic lysis of adhesions (58660, Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) is the higher-valued code, so you should list it first with modifier -59 ( Distinct procedural service ...

Lysis of adhesions may be done using a method called laparoscopy. This method uses a few small cuts (incisions) in your belly (abdomen). Or it may be done as open surgery, with a large cut. You are given medicine (general anesthesia). This puts you into a deep sleep through the procedure. For a laparoscopy, the healthcare provider makes 2 to 4 ...Lysis of Adhesions. Coders should carefully review the entire operative report to determine the clinical significance of the adhesions and the complexity of the lysis of adhesions. Coders should not code adhesions and lysis thereof, based solely on mention of adhesions or lysis in an operative report. As is customary with other surgeries, it is ...Laparoscopic lysis of adhesions. Laparoscopy procedures often include lysis of (incidental) adhesions, which are not separately billable most of the time.Apr 24, 2009 · Lysis of adhesions should not be reported together with any other surgical laparoscopic procedure. There are other rules out there and I can tell you some will code the lysis other's won't. I haven't had any luck getting lysis paid so I quit coding unless it was by itself, and started adding the 22 modifier if extensive, leaving it as inclusive ... Put the plastic piece in your mouth and take a slow, deep breath, then let the air out and cough. Repeat these steps 10 times every hour. Intake and output may be measured. Healthcare providers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating.Skip Separate Lysis Coding. You should not separately bill for the laparoscopic lysis of adhesions using 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]). “The lysis of adhesions is really getting to the surgical field and pathology, the location where the surgery will be performed, Ferragamo ...Hospitalizations containing a primary or nonprimary ICD-9-CM procedure code for adhesiolysis, but without DRG 150 or 151, were defined as secondary adhesiolysis-related hospitalizations ... Prevention of intra-abdominal adhesions in gynaecological surgery. Reprod Biomed Online. 2008, 17: 303-306. 10.1016/S1472-6483(10)60211-8.Jun 21, 2012 · 1. Laparoscopic lysis of adhesions. 2. Laparoscopic cholecystectomy w/ intraoperative cholangiogram. adhesions in the right upper quadrant. port placed under direct vision. adhesions were lysis using electrocautery and sharp dissection. Approx 15 min of operative time. peritoneum overlying the gallbladder was incised. 0. Nov 8, 2012. #2. Since the adhesiolysis is extensive, this can be given a code for its own. You can cod eboth of them with a modifier- 51. If the payer refuses (mostly with medicare) to recognise so, even with a significant documentation as "extensive adhesiolysis ", then the second time you can go for the code for oopherectomy alone but ...Unless your doctor is doing the lysis of adhesions as the only procedure it is not separately reportable. If it was extensive and there is time in the op note you can use modifier 22.

Is it ever acceptable to code lysis of adhesions and drainage of follicular cysts with a hysterectomy? R. rebecca lopez Networker. Local Chapter Officer. Messages 35 Location Whittier, CA Best answers 0. Jan 30, 2009 #2 tah and lysis if your doctor documents that is was Unusual procedure services you can code modifer 22 and send …

There was an obstruction of the distal small bowel from an internal hernia from adhesions. These bands were lysed, all of the bowel was mobilized from the ligament of Treitz to the ileocecal junction. The prior anastomosis was noted, was patent and the obstruction was just distal to this. We assured that the bowel was healthy.In the complex world of medical billing and coding, accurate documentation is crucial for maximizing revenue and ensuring efficiency. One tool that can greatly aid in this process ...Lysis of adhesions should not be reported together with any other surgical laparoscopic procedure. There are other rules out there and I can tell you some will code the lysis other's won't. I haven't had any luck getting lysis paid so I quit coding unless it was by itself, and started adding the 22 modifier if extensive, leaving it as inclusive ...Laparoscopic lysis of adhesions 9540004. SNOMED CT Concept 138875005. Procedure 71388002. Procedure by site 362958002. Physical examination 5880005. Abdomen endoscopy 108191006. Laparoscopy 73632009. Laparoscopic lysis of adhesions 9540004.Lysis of Adhesions. Coders should carefully review the entire operative report to determine the clinical significance of the adhesions and the complexity of the lysis of adhesions. Coders should not code adhesions and lysis thereof, based solely on mention of adhesions or lysis in an operative report. As is customary with other surgeries, it is ...If you get healthcare services and receive a statement or bill, you’ll see medical CPT codes on the paperwork. But what do they all mean? Here’s a guide to reading CPT codes to see...Adhesiolysis recovery time. You may have discomfort around your abdomen for about 2 weeks. You should be able to return to regular activities in 2 to 4 weeks. It may also take several weeks for ... A retrospective study by Gajjar comparing 30 open PD catheter placements to 45 simple laparoscopic placements and lysis of adhesions showed an immediate functional success of 97.8% in the laparoscopic group versus 80% in the open group (p =0.014) even though 31% of the laparoscopic patients had prior abdominal surgery versus 16% of the open ...

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Mar 8, 2013 · Skip Separate Lysis Coding. You should not separately bill for the laparoscopic lysis of adhesions using 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]). “The lysis of adhesions is really getting to the surgical field and pathology, the location where the surgery will be performed, Ferragamo ... Nov 5, 2008 ... WHAT TO DO: Do...Report a laparoscopic lysis code (44180, 58660) if the following are documented in the medical record: Adhesions are multiple ...Laparoscopic lysis of adhesion of peritoneum 708614008. Laparotomy and division of peritoneal adhesions 287853009. hierarchies. a selection of possible paths. SNOMED CT Concept 138875005. Procedure 71388002. Procedure by method 128927009. Operation on trunk 74943008. Operation on abdominal region 21371007.easily achieved. There were significant adhesions of omentum to the anterior abdominal wall. A 5 mm port was placed in the left lower quadrant. These adhesions were taken down using the Harmonic scalpel. A 10 mm port was placed in the right lower quadrant, a 5 mm port was placed in the right upper quadrant.In this case, the laparoscopic lysis of adhesions (58660, laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) is the …Medical Coding. OB/GYN . Wiki lysis ... but can I bill the lysis adhesions 44005 along with the 58720 for salpingo-oophorectomy? M. [email protected] ... Nov 6, 2015 #2 You should be able to get the codes and charges that the OB/GYN used and bill the claim the exact same way with an 80 modifier to show that your surgeon was the …If the surgeon spends significant time performing lysis of adhesions, but you cannot find a CPT® code specific to the anatomic location, you can account for the additional work … See morePROCEDURE: Laparoscopic Lysis of Adhesions[13] WHAT TO DO: Do...Report a laparoscopic lysis code (44180, 58660) if the following are documented in the medical record: Adhesions are multiple or dense, they cover the primary operative site or the lysis adds considerable time to the operative procedure and increases the risk to …Sep 20, 2011 · Sep 20, 2011. #1. I need help with finding a CPT code to fit the procedure performed by the doctor. The title of the operation was laparoscopy, lysis of adhesions, and drainage of abscesses with irrigation. I will submit the operative report with the claim but I still need to know what CPT code to use. There is "taking down" and "freeing up ... Further, laparoscopic adhesiolysis is a demanding procedure and the required expertise is not always available during off-duty hours, especially in lower volume hospitals. 3. Di Saverio S ; Birindelli A ; ... Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of … ….

The official description of CPT code 58660 is: Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure). 3. Procedure. The patient is placed in the dorsal lithotomy position, and the abdomen is prepped and draped. General anesthesia is administered. The key points to arthroscopic lysis of adhesions for the stiff knee arthroplasty are summarized in Table 1. Fig 1. Arthroscopic view of right knee, infrapatellar pouch, with arthroscope in inferolateral portal and shaver in inferomedial portal. Granulation tissue and scar tissue are being debrided to expose the femoral component (one should ...UPDATE 1/30/15: Watch the updated version of this animation: https://www.youtube.com/watch?v=LVP6JngpgEEThis 3D medical animation shows how adhesions in the ...The mouth and anus have mucocutaneous margins. Numerous procedures (e.g., biopsy, destruction, excision) have CPT codes that describe the procedure as an integumentary procedure (CPT codes 10000-19999) or as a digestive system procedure (CPT codes 40000-49999).Sep 20, 2011 · Sep 20, 2011. #1. I need help with finding a CPT code to fit the procedure performed by the doctor. The title of the operation was laparoscopy, lysis of adhesions, and drainage of abscesses with irrigation. I will submit the operative report with the claim but I still need to know what CPT code to use. There is "taking down" and "freeing up ... CPT code 49654, for laparoscopic repair of an incision hernia should not be coded in addition to 47560 for the lap cholecystectomy. Scenario # 3 ... Answer: No, 44005 enterolysis (freeing of adhesions) for an open procedure and 44180, laparoscopic enterolysis, are both designated as “separate procedures.” ...The CPT code for laparoscopic lysis of intestinal adhesions is CPT code 58660.It is the surgical procedure of removing and breaking up adhesions (bands of scar tissue) that are blocking the intestines or other organs in the abdominal cavity.Lysis of Adhesions. A patient with chronic pelvic pain and severe dyspareunia presents for laparoscopy. The patient was brought to the operating room and given general anesthesia. The laparoscopy was started and numerous adhesions were found between the omentum and uterus, as well as the omentum and anterior …Unless your doctor is doing the lysis of adhesions as the only procedure it is not separately reportable. If it was extensive and there is time in the op note you can use modifier 22. Laparoscopic lysis of adhesions cpt code, Previous cohort studies and meta-analyses have shown that laparoscopy can be associated with improved outcomes compared with open surgery for adhesional small bowel obstruction. 2–4 However, there are concerns that these studies have been prone to selection bias because patients predicted to have less complex intra-abdominal adhesions might ..., UPDATE 1/30/15: Watch the updated version of this animation: https://www.youtube.com/watch?v=LVP6JngpgEEThis 3D medical animation shows how adhesions in the ..., Adhesion lysis is surgery to cut these adhesions, freeing the pelvic organs and restoring proper anatomy and function. The procedure is also known as lysis of ..., 0. Apr 2, 2008. #2. Unless you have documentation that the lysis of adhesions is very large it is included in the exploratory code. The documentation cannot only state that the lysis was done to obtain access to the site, it must be excessive. Most times you will not get the documentation you need in order to bill this separately., The CPT Code for laparoscopic lysis Omental Adhesions is 44180. This code is used to describe a minimally invasive surgical procedure that is performed to remove adhesions that have formed between the omentum, a fatty tissue in the abdomen, and other structures in the abdominal cavity. Adhesions can develop as a result of previous abdominal, ICD-10-PCS 0JN80ZZ is a specific/billable code that can be used to indicate a procedure. Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-PCS), Between June 2000 and October 2011, 414 patients were originally identified by CPT codes for lysis of adhesions and laparoscopic lysis of adhesions. Of those 414 patients, 24.6 per cent (n = 102) were included in this study based on the previously mentioned inclusion/exclusion criteria., How do I code laparoscopic lysis of adhesions for a patient 11 days post gastric bypass. The patient returned to the hospital with severe epigastric pain. The physician performed a laparoscopy and noted a partial obstruction at the mesocolic defect. Some sutures were cut to relieve the obstruction., May 19, 2017 · In these cases, if clinically reported and documented, you can bill both procedures using the appropriate CPT ® lysis codes. Example: Appropriate coding would include 50230 for the open transabdominal radical nephrectomy and lysis of limited adhesions and 58660 for the laparoscopic lysis of extensive pelvic adhesions. , Laparoscopy, surgical, with lysis of adhesions (salpingolysis, ovariolysis) (separate procedures), Jul 31, 2015 · SNOMED code: 708614008: name: Laparoscopic lysis of adhesion of peritoneum: status: active: date introduced: 2015-07-31: fully specified name(s) Laparoscopic lysis of adhesion of peritoneum (procedure) synonyms: Laparoscopic lysis of peritoneal adhesion; Laparoscopic lysis of adhesion of peritoneum; attributes - group3: Method: Inspection ... , Separation or Lysis of Adhesions is the surgical removal of an abnormal formation of a fibrous band occurring between neighboring tissues and/or organs. The reasons for formation of these adhesions are as follows: Previous surgery in the affected part of the body. Trauma., myomas with total weight greater than 250 g, abdominal approach $ 1,212 ADHESION LYSIS 58740 Lysis of adhesions (salpingolysis, ovariolysis) $ 937 Example: STEP 1: Procedure Code 3E0 + Body Part L + Approach 0 + Device 5 + Qualifier Z = STEP 2: 3E0L05Z Surgeon CPT& DRG Codes, easily achieved. There were significant adhesions of omentum to the anterior abdominal wall. A 5 mm port was placed in the left lower quadrant. These adhesions were taken down using the Harmonic scalpel. A 10 mm port was placed in the right lower quadrant, a 5 mm port was placed in the right upper quadrant., myomas with total weight greater than 250 g, abdominal approach $ 1,212 ADHESION LYSIS 58740 Lysis of adhesions (salpingolysis, ovariolysis) $ 937 Example: STEP 1: Procedure Code 3E0 + Body Part L + Approach 0 + Device 5 + Qualifier Z = STEP 2: 3E0L05Z Surgeon CPT& DRG Codes , Hmm, well without seeing the note, I'd say if the scope was used during the procedure then it's a laparoscopic procedure and then it would be an unlisted code for a lap trachelectomy. Lysis is usually always included in the main procedure but can add a 22 modifier if documentation supports significant extra work., Scenario 4: Check Out Your Lap Lysis Code Options. ... Solution: You have only two codes for laparoscopic lysis of adhesions: 44180 (Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)) and 58660 (Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) ..., First, Examine Adhesiolysis CPT Codes. Although ob-gyns generally deal with lysis of adhesions in only four sites, CPT provides six codes for the associated procedures: 44005 -- Enterolysis (freeing of intestinal adhesion) (separate procedure) 44180 -- Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure), 44180 Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure) 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) Sources 1. Current Procedural Terminology (CPT®), (2017) – American Medical Association 2. ICD-9-CM Coding Guidelines. (2013, January 1). , Lysis of adhesions. The article “To lyse or not to lyse adhesions,” published in the AHA’s Coding Clinic for HCPCS, Fourth Quarter 2018 newsletter, provided coding advice in two Q&A’s stating that lysis of adhesions (58660) should be additionally reported with other laparoscopic surgical codes (58661, 58662)., 5 days ago · Lysis of Adhesions. Coders should carefully review the entire operative report to determine the clinical significance of the adhesions and the complexity of the lysis of adhesions. Coders should not code adhesions and lysis thereof, based solely on mention of adhesions or lysis in an operative report. As is customary with other surgeries, it is ... , The mouth and anus have mucocutaneous margins. Numerous procedures (e.g., biopsy, destruction, excision) have CPT codes that describe the procedure as an integumentary procedure (CPT codes 10000-19999) or as a digestive system procedure (CPT codes 40000-49999)., 1. Diagnostic laparoscopy. 2. Laparoscopic lysis of adhesions. A midline infraumbilical incision was made and carried through subcutaneous tissue to the fascia at the base of the umbilicus, which was grasped and elevated. An incision was then made in the fascia. A heavy Vicryl was placed on either side of the fascial defect., Diagnostic Laparoscopy lysis of adhesions, hysteroscopy D&C and Chromopertubation. I coded this as 58662 and 58558, I know that the Chromopertubation is included in the procedure. Second Patient: Laparoscopic assisted vaginal hysterectomy, bilateral salpingo-oophorectomy and larascopic appendectomy. I coded this as 58550, …, 1. Diagnostic laparoscopy. 2. Laparoscopic lysis of adhesions. A midline infraumbilical incision was made and carried through subcutaneous tissue to the fascia at the base of the umbilicus, which was grasped and elevated. An incision was then made in the fascia. A heavy Vicryl was placed on either side of the fascial defect., If laparoscopic lysis of adhesions is the only procedure performed can we code 49329 without the documentation of"extensive". Does that rule only appy when..., Construction adhesive makes these home improvements — among others — much easier. Expert Advice On Improving Your Home Videos Latest View All Guides Latest View All Radio Show Late..., Tumor lysis syndrome (spontaneous); Tumor lysis syndrome following antineoplastic drug chemotherapy; code for adverse effect, if applicable, to identify drug (T45.1X5) ICD-10-CM Diagnosis Code E88.3 Tumor lysis syndrome, Lysis of adhesions may be done using a method called laparoscopy. This method uses a few small cuts (incisions) in your belly (abdomen). Or it may be done as open surgery, …, the proper CPT code would be 58575 (Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed). ... If there was just lysis of adhesions without debulking, then 58150-22 or 58956-52., 9. Similar codes to CPT 58662. Five similar codes to CPT 58662 and how they differentiate from CPT 58662 are: CPT 58660: This code is used for laparoscopic lysis of adhesions, which is a different procedure than the fulguration or excision of lesions.; CPT 58661: This code is used for laparoscopic removal of the ovary and/or fallopian tube, which is a …, 1. 2021 Coding & Payment Quick Reference. Select Laparoscopic Cholecystectomy Procedures with and without Common Bile Duct Exploration (CBDE) Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used …, The CPT code for gallbladder removal surgery is 47562 (laparoscopy, surgical; cholecystectomy). This code is used to bill for the surgical removal of the gallbladder, whether performed using a laparoscopic or open approach. It is important to use the appropriate CPT code when submitting claims for reimbursement and to ensure …