How To Use CPT Code 43277

CPT 43277 describes the endoscopic retrograde cholangiopancreatography (ERCP) procedure with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct. 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 43277?

CPT 43277 is used to describe the endoscopic retrograde cholangiopancreatography (ERCP) procedure with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct. This code is used when a physician performs an ERCP procedure and uses a balloon dilation technique to treat bile duct strictures. The code also includes the option for a sphincterotomy, which is an incision made by the physician.

2. Official Description

The official description of CPT code 43277 is: ‘Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct.’

3. Procedure

1. The physician administers anesthesia to the patient.
2. A scope is inserted through the patient’s mouth and passed down into the duodenum and then the biliary tract duct.
3. A balloon on the tip of a catheter is passed through the ERCP endoscope and inflated at the site of the stricture, enlarging the blocked duct or the sphincter (ampulla).
4. If necessary, the physician may also perform a sphincterotomy, which involves making an incision to further open the duct or ampulla.
5. The physician completes the procedure and removes the scope.

4. Qualifying circumstances

CPT 43277 is used for patients who require an ERCP procedure with balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed. This procedure is typically performed to treat bile duct strictures. It is important to note that CPT 43277 should not be reported in conjunction with other codes for the same lesion or for incidental dilation using a balloon for stone/debris removal.

5. When to use CPT code 43277

CPT code 43277 should be used when a physician performs an ERCP procedure with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed. This code should not be used for other procedures or when reporting other specific codes for the same lesion or incidental dilation.

6. Documentation requirements

To support a claim for CPT 43277, the physician must document the following information:

• Indication for the ERCP procedure
• Details of the balloon dilation, including the specific duct(s) or ampulla treated
• Documentation of any sphincterotomy performed
• Date and duration of the procedure
• Any complications or additional procedures performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 43277, ensure that the procedure meets the criteria described in the official description. It is important to note that CPT 43277 should not be reported in conjunction with other codes for the same lesion or for incidental dilation using a balloon for stone/debris removal. Additionally, if multiple strictures are dilated during the same session, use modifier 59 for each additional stricture dilated. For bilateral balloon dilation, CPT 43277 may be reported twice with modifier 59 appended to the second procedure.

8. Historical information

CPT 43277 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 with balloon dilation of a biliary duct to treat a stricture.
2. A physician performing an ERCP procedure with balloon dilation of the ampulla and a sphincterotomy to treat a patient with a blocked pancreatic duct.
3. A physician performing an ERCP procedure with balloon dilation of multiple strictures in the biliary ducts.
4. A physician performing an ERCP procedure with balloon dilation of the ampulla and a sphincterotomy for a patient with recurrent gallstones.
5. A physician performing an ERCP procedure with balloon dilation of a biliary duct and a sphincterotomy to treat a patient with a bile duct stricture caused by a tumor.
6. A physician performing an ERCP procedure with balloon dilation of the ampulla and a sphincterotomy for a patient with pancreas divisum.
7. A physician performing an ERCP procedure with balloon dilation of a biliary duct and a sphincterotomy to remove a foreign body.
8. A physician performing an ERCP procedure with balloon dilation of the ampulla and a sphincterotomy to remove a tumor from the pancreatic duct.
9. A physician performing an ERCP procedure with balloon dilation of a biliary duct to treat a patient with primary sclerosing cholangitis.