How To Use CPT Code 43275

CPT 43275 describes the endoscopic retrograde cholangiopancreatography (ERCP) procedure, specifically the removal of foreign bodies or stents from the biliary/pancreatic ducts. 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 43275?

CPT 43275 is used to describe the endoscopic retrograde cholangiopancreatography (ERCP) procedure, specifically the removal of foreign bodies or stents from the biliary/pancreatic ducts. This code should be used when the physician performs the ERCP procedure and removes one or more foreign bodies or stents during the same session.

2. Official Description

The official description of CPT code 43275 is: ‘Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s).’ It is important to note that this code should not be reported in conjunction with codes 43260, 43274, or 43276. Additionally, if the removal of a stent from the biliary or pancreatic duct is performed without an ERCP, code 43247 should be used instead. Only report code 43275 once for the removal of one or more foreign bodies or stents during the same session.

3. Procedure

1. The physician begins the ERCP procedure by passing an endoscope through the patient’s oropharynx, esophagus, stomach, and into the small intestine.
2. Once the endoscope reaches the duodenum, the physician visually inspects the papilla of vater, the opening where the pancreatic and common bile ducts enter the small intestine.
3. If foreign bodies or stents are present in the biliary or pancreatic ducts, the physician carefully removes them using specialized instruments.
4. The physician may use fluoroscopic guidance to ensure the safe and effective removal of the foreign bodies or stents.
5. After the removal, the physician completes the ERCP procedure and removes the endoscope from the patient.

4. Qualifying circumstances

CPT 43275 is appropriate when the physician performs an ERCP procedure and removes foreign bodies or stents from the biliary/pancreatic ducts. It is important to note that this code should not be reported in conjunction with codes 43260, 43274, or 43276. Additionally, if the removal of a stent from the biliary or pancreatic duct is performed without an ERCP, code 43247 should be used instead.

5. When to use CPT code 43275

CPT code 43275 should be used when the physician performs an ERCP procedure and removes foreign bodies or stents from the biliary/pancreatic ducts during the same session. It is important to follow the guidelines and not report this code in conjunction with codes 43260, 43274, or 43276. If the removal of a stent from the biliary or pancreatic duct is performed without an ERCP, code 43247 should be used instead.

6. Documentation requirements

To support a claim for CPT 43275, the physician must document the following information:

• Indication for the ERCP procedure
• Specific foreign bodies or stents removed from the biliary/pancreatic ducts
• Date and duration of the procedure
• Fluoroscopic guidance, if used
• Any complications or additional procedures performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 43275, ensure that the procedure involves the removal of foreign bodies or stents from the biliary/pancreatic ducts during an ERCP. Do not report this code in conjunction with codes 43260, 43274, or 43276. If the removal of a stent from the biliary or pancreatic duct is performed without an ERCP, use code 43247 instead. It is important to follow the specific guidelines and documentation requirements for accurate billing.

8. Historical information

CPT 43275 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Examples

1. A physician performing an ERCP procedure and removing a foreign body from the biliary duct during the same session.
2. A gastroenterologist removing a stent from the pancreatic duct during an ERCP procedure.
3. An interventional radiologist performing an ERCP procedure and removing multiple foreign bodies from the biliary and pancreatic ducts.
4. A surgeon removing a stent from the biliary duct and a foreign body from the pancreatic duct during an ERCP procedure.
5. An endoscopist performing an ERCP procedure and removing a foreign body from both the biliary and pancreatic ducts.
6. A hepatologist removing multiple stents from the biliary duct during an ERCP procedure.
7. A gastroenterologist removing a foreign body from the pancreatic duct and a stent from the biliary duct during an ERCP procedure.
8. An interventional radiologist performing an ERCP procedure and removing a foreign body from the biliary duct.