Laparoscopy, surgical; cholecystectomy
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Laparoscopic cholecystectomy billed without documented gallbladder pathology
Common47562 (laparoscopic cholecystectomy) requires documented gallbladder disease: acute/chronic cholecystitis, symptomatic cholelithiasis, biliary colic. Denied when imaging doesn't show stones/inflammation, when asymptomatic incidental gallstones, or when converted to open but open code not used.
Common Causes
- • Ultrasound shows gallstones but patient asymptomatic - not medical necessity
- • No pre-op imaging documenting stones or inflammation
- • Procedure converted to open cholecystectomy - should bill 47600, not 47562
Resolution Strategy
Document medical necessity: 'Patient with symptomatic cholelithiasis, multiple episodes biliary colic. Ultrasound confirmed multiple gallstones with gallbladder wall thickening. Laparoscopic cholecystectomy performed via 4 ports, gallbladder dissected from liver bed, cystic duct and artery identified and clipped. Specimen removed via umbilical port.' Must show: symptoms (biliary colic, pain), imaging confirming stones/inflammation, procedure completed laparoscopically. If converted to open, bill 47600 instead. Appeal with pre-op imaging and symptom documentation.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For laparoscopic removal of gallbladder in patients with cholelithiasis, cholecystitis, or biliary dyskinesia requiring surgical intervention
Common Scenarios
Documentation Requirements
- Indication for surgery and preoperative imaging findings
- Operative findings including gallbladder appearance and adhesions
- Critical view of safety achieved before clipping cystic duct and artery
- Technique for gallbladder extraction and specimen description
- Any complications or conversion to open approach
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes laparoscopic exploration of abdominal cavity
- Includes dissection and removal of gallbladder
- Diagnostic laparoscopy bundled when performed same session
- Intraoperative cholangiography coded separately with 47563 if performed
- Liver biopsy if performed coded separately with modifier 59
Exclusions
- 47600 (open cholecystectomy if converted from laparoscopic)
- 47563 (intraoperative cholangiography without separate modifier)
- 49320 (diagnostic laparoscopy without separate indication)
Coding Notes
Clinical scenarios
- Indication for surgery and preoperative imaging findings
- Operative findings including gallbladder appearance and adhesions
- Critical view of safety achieved before clipping cystic duct and artery
- Indication for surgery and preoperative imaging findings
- Operative findings including gallbladder appearance and adhesions
- Critical view of safety achieved before clipping cystic duct and artery
- Indication for surgery and preoperative imaging findings
- Operative findings including gallbladder appearance and adhesions
- Critical view of safety achieved before clipping cystic duct and artery
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 47562 is the billing code for "Laparoscopy, surgical; cholecystectomy". For laparoscopic removal of gallbladder in patients with cholelithiasis, cholecystitis, or biliary dyskinesia requiring surgical intervention
Medicare pays approximately $648.87 for CPT 47562 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 47562 has a total RVU of 27.31, broken down as: Work RVU 12.32, Practice Expense RVU 13.81, and Malpractice RVU 1.18. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 47562 is "Laparoscopic cholecystectomy billed without documented gallbladder pathology". 47562 (laparoscopic cholecystectomy) requires documented gallbladder disease: acute/chronic cholecystitis, symptomatic cholelithiasis, biliary colic. Denied when imaging doesn't show stones/inflammation, when asymptomatic incidental gallstones, or when converted to open but open code not used. Common causes include: Ultrasound shows gallstones but patient asymptomatic - not medical necessity; No pre-op imaging documenting stones or inflammation. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 47562 include: Indication for surgery and preoperative imaging findings; Operative findings including gallbladder appearance and adhesions; Critical view of safety achieved before clipping cystic duct and artery; Technique for gallbladder extraction and specimen description. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 47562: Includes laparoscopic exploration of abdominal cavity. Includes dissection and removal of gallbladder Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 47562 include: 22 (Increased procedural services for difficult cases), 51 (Multiple procedures performed same session), 52 (Reduced services if procedure not completed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 47562 is 60-90 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.