Sunday, 11 December 2016

Medicare Procedure Code 47562

cpt 47562

CHOLECYSTECTOMY

47562 Laparoscopy, surgical; cholecystectomy

APPLICABLE CODES

The following list(s) of codes is provided for reference purposes only and may not be all inclusive. 

Listing of a code in this guideline does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. 

The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. 

Other Policies and Guidelines may apply.

CPT Code & Description

47562 Laparoscopy, surgical; cholecystectomy
47563 Laparoscopy, surgical; cholecystectomy with cholangiography

Medical Necessity Guidelines: Cholecystectomy-Open and Laparoscopic 

Note: While you may not be the provider responsible for obtaining prior authorization, as a condition of payment you will need to make sure that prior authorization has been obtained. Tufts Health Plan requires the use of an InterQual SmartSheet to obtain prior authorization for Cholecystectomies.

In order to obtain prior authorization for procedure(s), choose appropriate InterQual SmartSheet(s) listed below. The completed SmartSheet(s) must be sent to the applicable fax number listed above, according to Plan.

 Cholecystectomy, Laparoscopic

 Cholecystectomy, Laparoscopic, Cholangiogram Intraoperative with Laparoscopic Cholecystectomy

 Cholecystectomy, Open

 Cholecystectomy, Open, Cholangiogram Intraoperative with Open Cholecystectomy

CHOLECYSTECOMY, LAPAROSCOPIC

The following CPT code(s) require prior authorization:

Code &Description

47562 Laparoscopy, surgical; cholecystectomy

Denominator Definition

Any member who underwent an appendectomy or cholecystectomy (laparoscopic or other) during the 365 day period ending 30 days prior to the end of the measurement year.

Denominator Codes

Appendectomy or laparoscopic appendectomy  
CPT code(s):  44950, 44955, 44960, 44970 

Cholecystectomy or laparoscopic cholecystectomy  

CPT code(s):  47562, 47563, 47564, 47600, 47605, 47610, 47612, 47620

Covariates descriptions: Procedure type:  This variable allows the model to adjust for type of surgery (open vs. laparoscopic) performed.

Type 1: Laparoscopic appendectomy = CPT code:  44970
Type 2: Appendectomy = CPT code(s):  44950, 44955, 44960,   
Type 3: Laparoscopic cholecystectomy = CPT procedure code(s):  47562, 47563, 47564
Type 4:  Cholecystectomy = CPT code(s):  47600, 47605, 47610, 47612, 47620

Laparoscopic Gall Bladder Removal CPT - 47562 

Laparoscopic cholecystectomy
ICD9 codes: 51.23, 51.24
CPT codes: 47562 – 47564 

Abdominal Procedures

A Whipple type pancreatectomy procedure (CPT codes 48150-48154) includes removal of the gallbladder. A cholecystectomy (e.g., CPT codes 47562-47564, 47600-47620) should not be reported separately.

Female Genital System

All surgical laparoscopic, hysteroscopic or peritoneoscopic procedures include diagnostic procedures. 
Therefore, CPT code 49320 is included in CPT codes 38120, 38570- 38572, 43280, 43651-43653, 44180-44227, 44970, 47562-47570, 49321-49323, 49650-49651, 54690-54692, 55550, 58545-58554, 58660- 58673, and 60650. CPT code 58555 is included in CPT codes 58558- 58565.

Surgical procedures

The goal of the surgical cross-over exhibits was to identify total volume, spending, price per procedure, and differences in cost across settings of care for procedures that can be performed either in hospital inpatient or hospital outpatient settings. 

The five major cross-over procedures were identified as the highest-volume procedures billed by surgeons in 2013 where at least 10 percent of the surgeries occurred at an inpatient hospital and at least 10 percent occurred in a hospital outpatient setting. 

Total spending includes insurer and enrollee payments for the facility portion of the surgical procedure; the physician portion billed on a separate professional claim is not included. Inpatient procedure costs include the hospital payment for the entire stay associated with the surgery. Outpatient procedure costs include the hospital payment for all lines on the outpatient claim for the surgery. 


The five procedures are laparoscopic cholecystectomy (CPT procedure code 47562 for outpatient surgeries and ICD-9 procedure code 5123 for inpatient surgeries), laparoscopic appendectomy (CPT 44970 and ICD-9 procedure code 4701), arthrodesis (CPT 22845 and 22551; and ICD-9 procedure code 8102), laparoscopic total hysterectomy (CPT 58570, 58571, 58572, and 58573; and ICD-9 procedure code 6841), and laparoscopic vaginal hysterectomy (CPT 58552, 58553, and 58554; and ICD-9 procedure code 6841).

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