(2023) CPT Codes For ERCP (Endoscopic Retrograde Cholangiopancreatography)
ERCP stands for “Endoscopic Retrograde Cholangiopancreatography. The ERCP CPT codes range from 43260 to 43278. Below you can find an explanation of this procedure, descriptions of the CPT codes for ERCP, and billing guidelines.
What is ECRP, and why is it used?
ERCP is an abbreviation for Endoscopic Retrograde Cholangiopancreatography. Doctors often use a method called ERCP to examine the bile and pancreatic ducts using an endoscope and fluoroscopy.
This procedure had commonly used to treat conditions such as gallstones, tumors, scarring, pancreatic cysts, pancreatitis, and tissue death. During the treatment, doctors can perform techniques like removing stones, breaking them down with lithotripsy inserting stents excising tumors, and dilating using balloons.
List with ERCP CPT codes
The CPT codes for ERCP are described below.
CPT code 43260: The CPT code 43260 covers the aspect of ERCP, which involves the collection of specimens(s).
CPT Code 43261: You may use 43261 for ERCP procedure involving a biopsy. This biopsy can be either multiple samples.
CPT Code 43262: CPT Code 43262 covers a ERCP procedure which includes both Papillotomy and sphincterotomy.
CPT Code 43263: The CPT code 43263 is for a ERCP procedure measuring pressure in the sphincter of Oddi.
CPT Code 43264: The CPT code 43264 encompasses the ERCP procedure with removal of debris and calculi from the bile and pancreatic ducts.
CPT Code 43265: The CPT code 43265 can be billed when a provider performs ERCP by removing stones using methods such as means, electrohydraulic techniques, or lithotripsy.
CPT Code 43274: This CPT code covers the ERCP procedure with inserting a catheter into a pancreatic duct. It also includes pre and post-dilation passing a guide wire, and performing sphincterotomy if necessary.
CPT Code 43275: The CPT code 43275 pertains to ERCP with the extraction of stents or foreign substances from the bile or pancreatic ducts.
CPT Code 43276: You can bill CPT Code 43276 when the Physician performs ERCP with both dilation of the pancreatic duct after the procedure. It also includes inserting a guide wire and performing sphincterotomy if required.
CPT Code 43277: CPT 43277 covers ERCP with sphincterotomy, as trans-endoscopic balloon dilatation of either the bile and pancreatic ducts or ampulla (sphincteroplasty).
CPT Code 43278: And the last ECRO code is reported for the removal of tumors, polyps, and other lesions. The procedure may include dilation, post dilation, and guide wire insertion.
Billing Guidelines
Once the surgeon inserts a wire and a tube into the ducts,, they will remove any existing stones that’s present. To do this, they may use a tool called a basket to catch the stones using the wire as guidance. Another method involves pulling the tube into the duodenum to release the stone. Additionally, a balloon can insert through the wire to extract the stones. If, for any reason, the surgeon cannot find or remove any stones or debris, please refrain from dialing 43264.
According to CMS, AMA discourages using codes when reporting 43264. It is important to note that if code 43260 had performed as a procedure, it covers specimen collection through brushing or washing.
When billing for code 43265 in column 1, patients should only request reimbursement for $458.27 (National Facility amount with a conversion factor of 35.9996). This is due to reporting constraints imposed by CPT advice and adjustments made by the Correct Coding Initiative (CCI).
Examples
Below are examples of procedures when ERCP CPT codes will be billed.
Example 1: A patient with a history of pancreatitis and recurring episodes of stomach discomfort has a narrowing in their pancreas called a stricture. The doctor performs an ERCP with balloon dilation. Places a stent to alleviate symptoms and improve drainage.
Example 2: A patient is showing symptoms that could be due to a gallstone in their bile duct, after reviewing the patient’s history and conducting the tests, it is determined that ERCP will require diagnosis and, in some cases, removal of the stone. The gastroenterologist successfully performed an ERCP procedure to remove the gallstone from the bile duct.
Example 3:A patient with cancer undergoes an ERCP procedure to relieve obstruction by inserting a stent into the common bile duct for palliative purposes. Following the completion of the procedure, it is essential to monitor and provide care for the patient.
Sources
- https://www.aapc.com/codes/cpt-codes/43260#:~:text=CPT%C2%AE%2043260%2C%20Under%20Endoscopic,Retrograde%20Cholangiopancreatography%20(ERCP)%20Procedures
- https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleID=57414
- https://www.horizonnjhealth.com/for-providers/resources/policies/reimbursement-policies-guidelines/endoscopic-retrograde
