How To Use CPT Code 43260

CPT code 43260 describes the diagnostic procedure known as Endoscopic Retrograde Cholangiopancreatography (ERCP), which involves the use of upper endoscopy and retrograde injection of contrast material to obtain fluoroscopic images of the gallbladder, pancreas, and bile ducts. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43260?

CPT 43260 is used to describe the diagnostic procedure called Endoscopic Retrograde Cholangiopancreatography (ERCP). This procedure combines upper endoscopy with the injection of contrast material into the biliary ducts to obtain fluoroscopic images of the gallbladder, pancreas, and bile ducts. The provider may also collect specimen(s) by brushing or washing for further diagnostic analysis.

2. Official Description

The official description of CPT code 43260 is: ‘Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure).’ It is important to note that CPT 43260 should not be reported in conjunction with other specific ERCP codes.

3. Procedure

1. The provider administers anesthesia to the patient.
2. A scope is passed through the patient’s mouth and down into the duodenum and biliary tract duct.
3. A catheter is used to inject contrast material into the pancreatic and biliary ducts.
4. Fluoroscopic images are obtained using a fluoroscope to identify any abnormalities.
5. The provider may collect specimen(s) by brushing or washing for further diagnostic analysis.
6. Once the procedure is complete, the provider removes the brush or catheter and the scope.

4. Qualifying circumstances

CPT 43260 is performed on patients who require a diagnostic evaluation of the gallbladder, pancreas, and bile ducts. The procedure is typically performed by a healthcare professional who specializes in endoscopy. It is important to note that CPT 43260 should not be reported in conjunction with other specific ERCP codes.

5. When to use CPT code 43260

CPT code 43260 should be used when a diagnostic ERCP procedure is performed, including the collection of specimen(s) by brushing or washing. It is important to ensure that the procedure meets the specific criteria outlined in the code description. CPT 43260 should not be reported in conjunction with other specific ERCP codes.

6. Documentation requirements

To support a claim for CPT 43260, the healthcare professional must document the following information:

• Indication for the ERCP procedure
• Details of the procedure performed, including the use of contrast material and specimen collection
• Date and duration of the procedure
• Fluoroscopic images obtained during the procedure
• Results of any specimen analysis, if applicable
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 43260, it is important to ensure that the procedure meets the specific criteria outlined in the code description. CPT 43260 should not be reported in conjunction with other specific ERCP codes. It is important to review the documentation requirements and ensure that all necessary information is included in the claim.

8. Historical information

CPT 43260 was added to the Current Procedural Terminology system on January 1, 1990. There have been updates to the code over the years, with the most recent change occurring on January 1, 2014, when the code description was revised.

9. Examples

1. A patient undergoes CPT 43260 for the diagnostic evaluation of suspected gallbladder stones.
2. A healthcare professional performs CPT 43260 to obtain fluoroscopic images of the pancreas for further evaluation.
3. A patient with suspected biliary duct obstruction undergoes CPT 43260 to identify the cause of the obstruction.
4. CPT 43260 is performed on a patient with a history of pancreatitis to assess the condition of the pancreas.
5. A healthcare professional performs CPT 43260 to collect specimens for laboratory analysis in a patient with suspected biliary tract infection.
6. A patient with recurrent abdominal pain undergoes CPT 43260 to evaluate the gallbladder and bile ducts for any abnormalities.
7. CPT 43260 is performed on a patient with suspected pancreatic cancer to obtain fluoroscopic images for further evaluation.
8. A healthcare professional performs CPT 43260 to collect specimens for cytological analysis in a patient with suspected pancreatic cysts.
9. A patient with a history of bile duct stones undergoes CPT 43260 to assess the condition of the bile ducts and identify any residual stones.
10. CPT 43260 is performed on a patient with suspected biliary strictures to obtain fluoroscopic images for further evaluation.