Hepatobiliary Resection & Biliary Reconstruction Scrubber
Complex hepatic resections face systematic commercial payer downcoding: plans reclassify extended trisegmentectomy (47125) to partial hepatectomy (47120), slashing over $1,290 per case. Concurrently, clearinghouses unlawfully bundle portal vein/hepatic artery reconstructions (+35221) and Roux-en-Y hepaticojejunostomy (47760) into parenchymal resection fees. Audit your HPB surgical claims for maximum allowable yield.
Hepatobiliary Resection & Biliary Reconstruction Scrubber
Model anatomic hepatectomies (47120–47130), defend extended trisegmentectomies from payer downcoding, audit vascular reconstruction add-ons (+35221), and prevent Roux-en-Y biliary bundling disallowances.
Statutory & Coding Analysis
All Couinaud anatomic resection hierarchies, vascular reconstructions (+35221), and Roux-en-Y biliary add-ons meet strict CMS NCCI Chapter VII standards.
Authority: CMS NCCI Policy Manual Chapter VII; AHPBA HPB Coding Consensus 2026
| CPT / HCPCS | Procedure Description | Modifier | Work RVU | Allowable | Clinical Rule & Note |
|---|---|---|---|---|---|
| 47125 | Hepatectomy, resection of liver; trisegmentectomy (Extended lobectomy) | None | 78.4 | $2740.00 | Anatomic extended hepatic resection supported by Couinaud segmentation. |
| 47760 | Anastomosis of intrahepatic ducts and gastrointestinal tract, Roux-en-Y | -59 / -XS | 27.7 | $965.00 | Distinct reconstructive procedure; 50% multi-procedure reduction applied. |
| +35221 | Repair blood vessel with vein graft; intra-abdominal (Portal vein / Hepatic artery) | Add-on | 32.8 | $1150.00 | Add-on code; exempt from multi-procedure discount. Paid at 100% allowable. |
| 76998 | Ultrasonic guidance, intraoperative (Hepatic parenchymal and vascular margin localization) | -26 | 2.1 | $185.00 | Professional component (-26) for real-time intraoperative parenchymal margin guidance. |
ISA*00* *00* *ZZ*SUBMITTER1 *ZZ*PAYER001 *260905*1300*^*00501*000000001*0*T*:~ GS*HC*SUBMITTER1*PAYER001*20260905*1300*1*X*005010X222A1~ ST*837*0001*005010X222A1~ BHT*0019*00*HPB9841*20260905*1300*CH~ NM1*85*2*AETHERA HPB SURGICAL GROUP*****XX*1982736450~ HL*1**20*1~ HL*2*1*22*0~ NM1*IL*1*LIVERPATIENT*AUDIT*****MI*HPB9201948~ CLM*HPB20260905*5040***11:B:1*Y*A*Y*Y~ HI*ABK:C22.0*ABF:K83.09*ABF:I81~ LX*1~ SV1*HC:47125*2740*UN*1***1~ DTP*472*D8*20260905~ LX*2~ SV1*HC:47760:59XS*965*UN*1***1~ DTP*472*D8*20260905~ LX*3~ SV1*HC:+35221:Addon*1150*UN*1***1~ DTP*472*D8*20260905~ LX*4~ SV1*HC:76998:26*185*UN*1***1~ DTP*472*D8*20260905~ SE*24*0001~ GE*1*1~ IEA*1*000000001~
Turn these Hepatobiliary & Surgical Oncology RCM insights into a practice-specific review
Frustrated by commercial payer downcoding of complex anatomic hepatectomies, bundling denials on vascular reconstructions, or co-surgery Modifier 62 rejections? Aethera's specialized HPB surgical coding team recovers every earned dollar. Let our senior AAPC-certified billing team audit 50 of your active claims or past denials — completely free. Results in 14 days after the BAA, complete intake and agreed success criteria.
Test our scrub rules and appeal workflow on 50 real claims. Zero commitment, no credit card required.
Enter your aging totals for an instant planning report. Uploaded files are processed locally; clinical intake is arranged separately.