How To Use CPT Code 43261

CPT 43261 describes the procedure known as endoscopic retrograde cholangiopancreatography (ERCP) with biopsy, single or multiple. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43261?

CPT 43261 is used to describe the endoscopic retrograde cholangiopancreatography (ERCP) procedure with biopsy, either single or multiple. This procedure involves the use of an endoscope to inject contrast material into the biliary ducts, allowing the provider to obtain fluoroscopic images of the gallbladder, pancreas, and bile ducts. Additionally, the provider may collect one or more tissue samples for biopsy during the procedure.

2. Official Description

The official description of CPT code 43261 is: ‘Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple. Do not report 43261 in conjunction with 43260. For percutaneous endoluminal biopsy of biliary tree, use 47543.’

3. Procedure

1. The provider administers anesthesia to the patient.
2. An endoscope is inserted 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 in the gallbladder, pancreas, and bile ducts.
5. The provider uses forceps to collect one or more tissue samples for biopsy.

4. Qualifying circumstances

CPT 43261 is performed on patients who require diagnostic evaluation of the biliary ducts. This procedure is typically used when there is a suspicion of abnormalities in the gallbladder, pancreas, or bile ducts. It is important to note that CPT 43261 should not be reported in conjunction with CPT 43260, and for percutaneous endoluminal biopsy of the biliary tree, CPT code 47543 should be used instead.

5. When to use CPT code 43261

CPT code 43261 should be used when the provider performs an endoscopic retrograde cholangiopancreatography (ERCP) procedure with biopsy, either single or multiple. It is important to ensure that the procedure meets the specific criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT 43261, the provider must document the following information:

• Reason for performing the ERCP procedure with biopsy
• Details of the procedure, including the use of contrast material and fluoroscopic imaging
• Number of tissue samples collected for biopsy
• Any complications or additional findings during the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 43261, it is important to ensure that the procedure meets the specific criteria outlined in the official description. CPT code 43261 should not be reported in conjunction with CPT 43260. Additionally, for percutaneous endoluminal biopsy of the biliary tree, CPT code 47543 should be used instead. It is important to follow the guidelines provided by the payer and use appropriate modifiers if necessary.

8. Historical information

CPT code 43261 was added to the Current Procedural Terminology system on January 1, 1994. There have been historical changes to the code, including a code change on January 1, 2002, which updated the description of the procedure.

9. Examples

1. A gastroenterologist performing an ERCP procedure with biopsy to evaluate a patient with suspected gallbladder abnormalities.
2. A hepatologist collecting tissue samples for biopsy during an ERCP procedure to investigate potential pancreatic issues.
3. An interventional radiologist using an endoscope to obtain fluoroscopic images of the bile ducts and collecting tissue samples for biopsy during an ERCP procedure.
4. A general surgeon performing an ERCP procedure with biopsy to assess a patient with suspected bile duct abnormalities.
5. An oncologist using an endoscope to inject contrast material and collect tissue samples for biopsy during an ERCP procedure to evaluate a patient with suspected pancreatic cancer.
6. A gastroenterologist performing an ERCP procedure with biopsy to investigate potential biliary tract abnormalities in a patient with recurrent jaundice.
7. An interventional radiologist using an endoscope to obtain fluoroscopic images of the pancreas and collecting tissue samples for biopsy during an ERCP procedure to assess a patient with suspected pancreatic cysts.
8. A hepatologist performing an ERCP procedure with biopsy to evaluate a patient with suspected primary sclerosing cholangitis.
9. A general surgeon using an endoscope to inject contrast material and collect tissue samples for biopsy during an ERCP procedure to investigate potential bile duct stones in a patient with recurrent abdominal pain.
10. An oncologist performing an ERCP procedure with biopsy to assess a patient with suspected metastatic liver cancer.