How To Use CPT Code 43262

CPT 43262 describes the procedure of endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy/papillotomy. 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 43262?

CPT 43262 is used to describe the procedure of endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy/papillotomy. This code is reported when a healthcare provider performs an ERCP, which combines upper endoscopy and retrograde injection of contrast material into the biliary ducts, along with a sphincterotomy or papillotomy. The sphincterotomy involves making an incision to open up or enlarge the sphincter of Oddi, while the papillotomy involves making an incision of the ampulla of Vater or hepatopancreatic duct.

2. Official Description

The official description of CPT code 43262 is: ‘Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy.’

3. Procedure

1. The healthcare provider administers anesthesia to the patient.
2. Using an endoscope, the provider passes a scope 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. Fluoroscopy is used to obtain X-ray images of the gallbladder, pancreas, and bile ducts.
5. If a narrowed sphincter is identified, the provider may perform a sphincterotomy by cutting the ring-like muscle at the opening of the duct.
6. A papillotomy may also be performed by making an incision of the ampulla of Vater or hepatopancreatic duct.
7. Once the procedure is complete, the provider withdraws the scope.

4. Qualifying circumstances

CPT 43262 is performed when an ERCP is conducted along with a sphincterotomy or papillotomy. This procedure is typically performed on patients with blocked bile ducts due to a narrowed sphincter. The sphincterotomy or papillotomy helps to open up or enlarge the sphincter of Oddi, allowing for better flow of bile and pancreatic juices.

5. When to use CPT code 43262

CPT code 43262 should be used when an ERCP is performed along with a sphincterotomy or papillotomy. It is important to note that this code should not be reported in conjunction with other codes for stent placement or replacement in the same location, or for percutaneous balloon dilation of biliary ducts or ampulla.

6. Documentation requirements

To support a claim for CPT 43262, the healthcare provider must document the following information:

• Indication for the ERCP procedure
• Details of the sphincterotomy or papillotomy performed
• Date of the procedure
• Start and end time of the procedure
• Any complications or adverse events
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43262, ensure that the procedure includes both the ERCP and the sphincterotomy or papillotomy. It is important to follow the guidelines and not report this code in conjunction with other codes for stent placement or replacement, or for percutaneous balloon dilation of biliary ducts or ampulla.

8. Historical information

CPT 43262 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A gastroenterologist performs an ERCP with sphincterotomy for a patient with a narrowed sphincter causing blocked bile ducts.
2. A patient with pancreatitis undergoes an ERCP with papillotomy to alleviate the narrowing of the ampulla of Vater.
3. A healthcare provider performs an ERCP with sphincterotomy and stone removal for a patient with gallstones causing biliary obstruction.
4. An ERCP with sphincterotomy is performed on a patient with suspected choledocholithiasis.
5. A patient with recurrent pancreatitis undergoes an ERCP with papillotomy to improve pancreatic duct drainage.
6. A gastroenterologist performs an ERCP with sphincterotomy and stent placement for a patient with a malignant biliary stricture.
7. An ERCP with sphincterotomy and lithotripsy is performed on a patient with large common bile duct stones.
8. A patient with chronic pancreatitis undergoes an ERCP with papillotomy and pancreatic duct stent placement.
9. A healthcare provider performs an ERCP with sphincterotomy and balloon dilation for a patient with a narrowed sphincter causing recurrent biliary obstruction.
10. An ERCP with sphincterotomy and stone extraction is performed on a patient with choledocholithiasis.