Summary & Overview
CPT 43273: ERCP Visualization of Pancreatic or Common Bile Ducts
CPT code 43273 identifies endoscopic visualization of one or more pancreatic or common bile ducts performed as part of a separately reportable endoscopic retrograde cholangiopancreatography (ERCP). This diagnostic maneuver is clinically important for evaluating ductal anatomy, diagnosing obstructive or inflammatory ductal disease, and guiding therapeutic decision-making during ERCP procedures. Nationally, CPT code 43273 is relevant for hospital outpatient departments and ambulatory endoscopy centers where ERCPs are commonly performed.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical role, typical sites of service, and the payer landscape. The publication also provides benchmarks and policy context relevant to billing and coverage of ERCP-related diagnostic visualization, highlights common billing considerations, and summarizes recent policy updates that affect national reimbursement and documentation expectations. Practical clinical context clarifies when the visualization component is reportable separately during ERCP and how it fits into the overall procedure workflow.
Data not available in the input for specific fee benchmarks, associated taxonomies, and ICD-10 diagnoses.
Billing Code Overview
CPT code 43273 describes visualization of one or more pancreatic or common bile ducts using a flexible endoscopic tube performed during a separately reportable endoscopic retrograde cholangiopancreatography (ERCP).
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Service type: Diagnostic endoscopic visualization during ERCP
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Typical site of service: Hospital outpatient department or ambulatory endoscopy center where ERCP procedures are performed.
Clinical & Coding Specifications
Clinical Context
A typical patient for 43273 is an adult presenting with suspected pancreatic duct pathology such as recurrent acute pancreatitis, suspected pancreatic ductal stricture, suspected intraductal papillary mucinous neoplasm (IPMN) evaluation, or persistent idiopathic pancreatitis. The patient commonly arrives to an endoscopy unit or hospital endoscopy suite after referral from gastroenterology or surgery. Pre-procedure workflow includes informed consent, review of anticoagulation, allergy and sedation assessment, and pre-procedure imaging review (abdominal ultrasound, CT, or MRCP).
Under moderate sedation or monitored anesthesia care in an ambulatory surgery center or hospital operating room/endoscopy suite, the gastroenterologist performs an ERCP. During the ERCP the provider cannulates the ampulla, advances a side-viewing duodenoscope, and selectively accesses the pancreatic duct. 43273 is reported when the provider uses a flexible endoscope to visualize one or more pancreatic or common bile ducts as a separately reportable diagnostic maneuver during ERCP. Clinical workflow after duct visualization may include pancreatography, therapeutic maneuvers (stent placement, sphincterotomy, stone extraction), specimen collection (brushings, biopsies), and post-procedure monitoring in recovery with discharge instructions and follow-up planning.
Coding Specifications
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