How To Use CPT Code 43276

CPT 43276 describes the procedure of endoscopic retrograde cholangiopancreatography (ERCP) with removal and exchange of stent(s) in the biliary or pancreatic duct. 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 43276?

CPT 43276 is used to describe the endoscopic retrograde cholangiopancreatography (ERCP) procedure, which involves the inspection of the duodenum, the papilla of vater, and the radiologic assessment of the pancreatic duct and the biliary tree. In addition to the inspection, the physician also performs the removal and exchange of a single duct stent. This code is used when the physician removes and replaces a stent in the biliary or pancreatic duct, including pre- and post-dilation, guide wire passage, and sphincterotomy if necessary.

2. Official Description

The official description of CPT code 43276 is: ‘Endoscopic retrograde cholangiopancreatography (ERCP); with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged.’

3. Procedure

1. The physician inserts an endoscope through the patient’s oropharynx, esophagus, stomach, and into the small intestine.
2. Direct visualization of the pancreatic and/or common bile ducts is performed.
3. The physician removes a stent from the biliary or pancreatic duct.
4. If necessary, the physician performs pre- and post-dilation of the duct.
5. A guide wire is passed through the duct.
6. If necessary, the physician performs a sphincterotomy (cut) to facilitate the stent exchange.
7. The physician exchanges the stent in the duct.
8. If additional stents are exchanged during the same session, modifier 59 should be appended to the code for each additional exchange.

4. Qualifying circumstances

CPT 43276 is performed when a physician removes and exchanges a stent in the biliary or pancreatic duct. The procedure may also involve pre- and post-dilation of the duct, guide wire passage, and sphincterotomy if necessary. It is important to note that CPT 43276 should not be reported in conjunction with CPT codes 43260 and 43275, or with CPT codes 43262 and 43274 for stent placement or exchange in the same duct.

5. When to use CPT code 43276

CPT code 43276 should be used when a physician performs the removal and exchange of a stent in the biliary or pancreatic duct. It is important to ensure that the procedure includes pre- and post-dilation, guide wire passage, and sphincterotomy if necessary. If additional stents are exchanged during the same session, modifier 59 should be appended to the code for each additional exchange.

6. Documentation requirements

To support a claim for CPT 43276, the physician must document the following information:

• Patient’s diagnosis and the need for stent removal and exchange
• Specific details of the procedure, including pre- and post-dilation, guide wire passage, and sphincterotomy if performed
• Date and duration of the procedure
• Number of stents exchanged
• Any additional procedures performed during the same session
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 43276, it is important to ensure that the procedure includes the removal and exchange of a stent in the biliary or pancreatic duct. The code should not be reported in conjunction with certain other codes, as mentioned earlier. Modifier 59 should be appended to the code if additional stents are exchanged during the same session. It is also important to follow the specific guidelines provided by the payer and to accurately document the procedure to support the claim.

8. Historical information

CPT 43276 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 performs an ERCP procedure on a patient with a biliary stent, removes the stent, performs pre- and post-dilation, passes a guide wire, and exchanges the stent.
2. During an ERCP procedure, a physician removes a pancreatic stent, performs a sphincterotomy, and exchanges the stent.
3. A patient with a biliary stent undergoes an ERCP procedure, during which the physician removes the stent, performs pre- and post-dilation, passes a guide wire, and exchanges the stent. Additionally, the physician performs a sphincterotomy.
4. During an ERCP procedure, a physician removes a biliary stent, performs pre- and post-dilation, passes a guide wire, and exchanges the stent. The procedure also involves the removal of a calculus by a mechanical device.
5. A patient with a pancreatic stent undergoes an ERCP procedure, during which the physician removes the stent, performs pre- and post-dilation, passes a guide wire, and exchanges the stent.