How To Use CPT Code 43278

CPT 43278 describes the procedure of endoscopic retrograde cholangiopancreatography (ERCP) with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed. 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 43278?

CPT 43278 is used to describe the endoscopic procedure known as endoscopic retrograde cholangiopancreatography (ERCP) with ablation of tumor(s), polyp(s), or other lesion(s). This procedure involves the inspection of the duodenum and the papilla of vater using an endoscope, followed by radiologic assessment of the pancreatic duct and the biliary tree. During the procedure, the provider may also perform pre- and post-dilation and guide wire passage, if necessary. The purpose of this procedure is to identify and ablate any tumors or lesions found in the biliary tract duct.

2. Official Description

The official description of CPT code 43278 is: ‘Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed.’

3. Procedure

1. After administration of anesthesia, the provider inserts an endoscope through the patient’s mouth and down into the duodenum.
2. If necessary, the provider may use a guidewire to direct a balloon through the ERCP endoscope.
3. The balloon is then inflated to enlarge the duct, allowing for better visualization of the biliary tract.
4. The provider identifies any tumors, polyps, or other lesions in the biliary tract duct.
5. If necessary, the provider performs ablation of the identified tumors or lesions using appropriate techniques.
6. Pre- and post-dilation may be performed to ensure proper access and treatment of the affected area.
7. The provider may also pass a guide wire during the procedure to aid in the placement of therapeutic devices or stents.

4. Qualifying circumstances

CPT 43278 is performed on patients who require endoscopic inspection of the duodenum and the papilla of vater, followed by radiologic assessment of the pancreatic duct and the biliary tree. The procedure is typically performed to identify and ablate tumors, polyps, or other lesions in the biliary tract duct. It is important to note that CPT 43278 should not be reported in conjunction with CPT 43277 for the same lesion, or with CPT 43260. For ampullectomy, CPT code 43254 should be used instead.

5. When to use CPT code 43278

CPT code 43278 should be used when performing endoscopic retrograde cholangiopancreatography (ERCP) with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage. It is important to ensure that the procedure meets the specific criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT code 43278, the provider must document the following information:

• Patient’s diagnosis and the need for endoscopic retrograde cholangiopancreatography (ERCP) with ablation
• Details of the procedure performed, including pre- and post-dilation, guide wire passage, and any other relevant techniques
• Date and duration of the procedure
• Findings during the procedure, including the identification and ablation of tumors, polyps, or other lesions
• Any complications or adverse events that occurred during or after the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 43278, it is important to ensure that the procedure meets the specific criteria outlined in the official description. The code should not be reported in conjunction with CPT 43277 for the same lesion, or with CPT 43260. It is also important to consider any additional guidelines or requirements set forth by the payer or insurance company. Proper documentation is essential to support the claim for reimbursement.

8. Historical information

CPT code 43278 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates or changes to the code since its addition.

9. Examples

1. A gastroenterologist performing endoscopic retrograde cholangiopancreatography (ERCP) with ablation of a tumor in the biliary tract duct.
2. An interventional radiologist using ERCP to identify and ablate polyps in the pancreatic duct.
3. A surgeon performing endoscopic retrograde cholangiopancreatography (ERCP) with ablation of multiple lesions in the biliary tree.
4. An oncologist utilizing ERCP to identify and ablate tumors in the papilla of vater.
5. A hepatologist performing endoscopic retrograde cholangiopancreatography (ERCP) with ablation of a lesion in the pancreatic duct.
6. A gastroenterologist using ERCP to identify and ablate a polyp in the biliary tract duct.
7. An interventional radiologist performing endoscopic retrograde cholangiopancreatography (ERCP) with ablation of a tumor in the papilla of vater.