Summary & Overview

CPT 43240: Endoscopic Pseudocyst Drainage with Stent Placement

CPT code 43240 represents an advanced therapeutic upper endoscopic procedure to drain pancreatic pseudocysts, often performed with endoscopic ultrasound guidance and placement of a transmural drainage catheter or stent. Nationally, this code captures a specialized intervention that intersects gastroenterology, interventional endoscopy, and hospital outpatient care, with implications for procedural coding accuracy, device utilization, and resource intensity.

Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, clinical context for when the procedure is used, and the components that influence billing and coverage decisions. The publication outlines common service settings, clinical rationale for drainage and stent placement, and operational considerations tied to endoscopic ultrasound and transmural access. It also identifies where data is not available in the input provided, including payer-specific reimbursement rates, associated taxonomies, and ICD-10 diagnoses.

This summary equips clinicians, billing professionals, and policy analysts with a clear, national-level understanding of CPT code 43240, what it covers clinically, and the topics to review further when evaluating reimbursement, clinical pathways, or compliance.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 43240endoscopic pseudocyst drainagetherapeutic endoscopyendoscopic ultrasoundtransmural stent placementgastroenterologyoutpatient procedureprocedure coding

Billing Code Overview

CPT code 43240 describes a therapeutic upper gastrointestinal endoscopic procedure in which a flexible endoscope is inserted through the mouth and advanced into the esophagus, stomach, and duodenum to drain a pancreatic pseudocyst. The procedure may include endoscopic ultrasound and placement of a transmural drainage catheter or stent.

Service type: Therapeutic endoscopy with pseudocyst drainage (endoscopic transluminal drainage with possible EUS guidance and stent or catheter placement)
Typical site of service: Hospital outpatient departments or ambulatory surgery centers where advanced endoscopic interventions and endoscopic ultrasound are performed

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient presents with abdominal pain, early satiety, and persistent post-pancreatitis fluid collection confirmed on CT scan as a pancreatic pseudocyst causing symptoms and possible gastric outlet compression. The gastroenterologist schedules an endoscopic transgastric drainage procedure. Under moderate sedation or monitored anesthesia care in the endoscopy suite or ambulatory surgical center, a flexible upper endoscope is advanced through the mouth into the stomach. Endoscopic ultrasound (EUS) is used to locate the pseudocyst and assess wall thickness and vascular structures. A transmural tract is created and dilated, and a drainage catheter or lumen-apposing metal stent is placed to allow continuous drainage of the pseudocyst contents into the stomach or duodenum. Specimens for culture or fluid analysis may be collected. Post-procedure monitoring includes recovery from sedation, observation for bleeding or infection, and imaging follow-up to confirm resolution. Typical sites of service are the hospital endoscopy unit, ambulatory surgical center, or endoscopy suite. Typical billing reflects an endoscopic drainage procedure with possible concurrent EUS and stent placement as described by 43240.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work or complexity is substantially greater than typical for `43240`.
`26`	Professional component	Use when reporting only the physician interpretation component of EUS or imaging associated with the procedure.
`52`	Reduced services	Use if the procedure was started but discontinued or performed in less than full extent.
`53`	Discontinued procedure	Use when the procedure is terminated due to complications or patient instability.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons.
`63`	Procedure performed on infants less than 4 kg	Rare; use per payer rules if applicable for neonatal patients.
`74`	Return to the operating/procedure room for a related procedure during the postoperative period	Use when an unplanned return to the procedure room is required for an issue related to the original `43240`.
`76`	Repeat procedure by same physician	Use if the same physician repeats `43240` subsequent to the initial attempt during the same day.
`77`	Repeat procedure by another physician	Use if another physician repeats the procedure on the same day.
`78`	Unplanned return to the operating/procedure room for a related procedure during the postoperative period (treatment of a complication)	Use when a complication of `43240` necessitates an emergent return to procedure room.
`80`	Assistant surgeon	Use when an assistant surgeon is documented and required during the procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician serves as an assistant and payer allows.
`TC`	Technical component	Use when billing only the institutional or technical component of services (rare for endoscopic procedures billed by facility).

Taxonomy Code	Specialty	Notes
`111N00000X`	Gastroenterology	Primary specialty performing EGD with pseudocyst drainage and EUS-guided interventions.
`207L00000X`	General Surgery	Surgeons who perform advanced endoscopic or combined surgical-endoscopic pseudocyst management.
`2080P0222X`	Surgery of the Hand (placeholder)	Data not applicable — use `Data not available in the input.`
`363L00000X`	Critical Care Medicine	Consult service for critically ill patients undergoing endoscopic drainage.
`1835P0207X`	Pain Medicine	Occasionally involved for complex sedation or chronic pancreatitis pain management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K86.3`	Pancreatic pseudocyst	Primary indication for endoscopic drainage via `43240` to relieve symptoms or treat infection.
`K85.9`	Acute pancreatitis, unspecified	Underlying condition that often leads to pseudocyst formation requiring drainage.
`K86.89`	Other specified diseases of pancreas	Includes pancreatic fluid collections or complications that may necessitate endoscopic drainage.
`K91.89`	Other postprocedural complications and disorders of digestive system	Used if procedure-related complications occur and require coding.
`R10.0`	Acute abdomen	Symptom code used when patients present with acute abdominal pain related to a pseudocyst.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43238`	Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple	Performed when mucosal biopsies are obtained during diagnostic evaluation prior to or during drainage.
`43259`	Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound, diagnostic	Represents the diagnostic EUS component that may be performed in conjunction with `43240` to locate and characterize the pseudocyst.
`43266`	Upper gastrointestinal endoscopy with transendoscopic drainage, placement of stent (eg, lumen-apposing)	Procedure for endoscopic transmural pseudocyst drainage using stent placement; often reported alongside or instead of `43240` depending on documentation.
`43255`	Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body, fragment or food bolus	May be performed if concurrent removal of obstructing material is required before drainage.
`43239`	Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or snare	Performed if concomitant lesion resection is needed during the same session.