How To Use CPT Code 43273

CPT 43273 describes the endoscopic cannulation of the papilla with direct visualization of the pancreatic or common bile duct(s) during an ERCP procedure. 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 43273?

CPT 43273 is used to describe the endoscopic cannulation of the papilla with direct visualization of the pancreatic or common bile duct(s) during an ERCP procedure. This code is reported separately in addition to the primary procedure codes and should be used once per procedure.

2. Official Description

The official description of CPT code 43273 is: ‘Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (List separately in addition to code(s) for primary procedure).’ It is important to note that this code should be used in conjunction with the primary procedure codes listed in the notes.

3. Procedure

1. During an ERCP procedure, the provider inserts a flexible tube to visualize one or more pancreatic or common bile ducts.
2. At the same session, the provider inserts a cholangioscope with the assistance of a guide wire to introduce a small tube into the papilla.
3. The guide wire is then removed, and a pressurized saline solution is administered to wash and properly visualize the pancreatic or bile duct.
4. The provider may visualize one or more ducts during the procedure.
5. Once the procedure is complete, the provider removes the scope.

4. Qualifying circumstances

CPT 43273 is performed during an ERCP procedure and is used when the provider needs to directly visualize the pancreatic or common bile duct(s) by cannulating the papilla. This procedure is typically performed for diagnostic or therapeutic purposes in patients with conditions affecting these ducts, such as gallstones, tumors, or strictures.

5. When to use CPT code 43273

CPT code 43273 should be used when the provider performs the endoscopic cannulation of the papilla with direct visualization of the pancreatic or common bile duct(s) during an ERCP procedure. It is important to report this code in addition to the appropriate primary procedure codes listed in the notes.

6. Documentation requirements

To support a claim for CPT 43273, the provider must document the following information:

• Indication for the ERCP procedure
• Specific details of the endoscopic cannulation of the papilla and direct visualization of the pancreatic or common bile duct(s)
• Date and duration of the procedure
• Any additional findings or interventions during the procedure
• Signature of the performing provider

7. Billing guidelines

When reporting CPT 43273, ensure that the procedure is performed during an ERCP and that the primary procedure codes are also reported. This code should be used once per procedure and should not be reported if the primary procedure codes have not been performed within the same session or in the previous seven days. It is important to follow the specific billing guidelines provided by payers and to use the appropriate modifiers, if required.

8. Historical information

CPT 43273 was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes an ERCP procedure for the evaluation of suspected gallstones. During the procedure, the provider performs the endoscopic cannulation of the papilla with direct visualization of the common bile duct. CPT code 43273 should be reported in addition to the appropriate primary procedure code for the ERCP.
2. A patient with a history of pancreatic cancer undergoes an ERCP procedure for the placement of a biliary stent. The provider performs the endoscopic cannulation of the papilla with direct visualization of the pancreatic duct. CPT code 43273 should be reported along with the primary procedure code for the ERCP and the code for the placement of the biliary stent.
3. A patient presents with recurrent episodes of pancreatitis. An ERCP procedure is performed to evaluate the pancreatic duct. The provider performs the endoscopic cannulation of the papilla with direct visualization of the pancreatic duct. CPT code 43273 should be reported along with the appropriate primary procedure code for the ERCP.
4. A patient with a history of bile duct strictures undergoes an ERCP procedure for therapeutic intervention. The provider performs the endoscopic cannulation of the papilla with direct visualization of the common bile duct. CPT code 43273 should be reported along with the primary procedure code for the ERCP and the code for the specific therapeutic intervention.
5. A patient presents with jaundice and suspected choledocholithiasis. An ERCP procedure is performed for diagnostic purposes. The provider performs the endoscopic cannulation of the papilla with direct visualization of the common bile duct. CPT code 43273 should be reported along with the appropriate primary procedure code for the ERCP.