Summary & Overview
CPT 43274: ERCP with Biliary or Pancreatic Duct Stent Placement
CPT code 43274 denotes an ERCP (endoscopic retrograde cholangiopancreatography) procedure with placement of a stent in a biliary or pancreatic duct. This code captures a common therapeutic endoscopic intervention used to relieve ductal obstruction, manage leaks, or facilitate drainage in patients with biliary or pancreatic disease. The procedure often involves guidewire passage, dilation, or sphincterotomy before stent insertion and is performed under fluoroscopic guidance.
Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, plus actionable details on billing attributes and common modifiers (provided separately). The publication outlines national benchmarks where available, highlights relevant coding and coverage considerations, and summarizes clinical scenarios that commonly drive use of this code. Practical takeaways include expected settings for service delivery (hospital outpatient departments and ambulatory surgery centers), the therapeutic intent of the code, and how this code fits within endoscopic procedural coding for biliary and pancreatic interventions.
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related codes is noted other sections of the full publication.
Billing Code Overview
CPT code 43274 describes an endoscopic retrograde cholangiopancreatography (ERCP) procedure in which the physician places a stent in a biliary or pancreatic duct. The procedure combines upper endoscopy with retrograde injection of contrast material into the biliary or pancreatic ducts to obtain fluoroscopic images and facilitate stent placement. The description notes that the procedure may require passage of a guidewire and dilators or an incision of a sphincter prior to stent insertion.
Service Type: Endoscopic therapeutic procedure (ERCP) with ductal stent placement
Typical Site of Service: Hospital outpatient department or ambulatory surgery center; may also occur in inpatient settings depending on clinical context
Clinical & Coding Specifications
Clinical Context
A 64-year-old patient presents to the hospital with obstructive jaundice, right upper quadrant pain, and cholestatic liver enzyme pattern. Cross-sectional imaging (abdominal ultrasound or CT) demonstrates a dilated common bile duct with a suspected distal biliary stricture, and the gastroenterology team schedules an endoscopic retrograde cholangiopancreatography with biliary stent placement (43274). The patient is admitted to an endoscopy-capable hospital facility. On the day of procedure the patient is consented, prepped, and given moderate to deep sedation or monitored anesthesia care depending on comorbidities. During the ERCP the endoscopist performs selective cannulation of the common bile duct, obtains cholangiograms under fluoroscopy, may perform sphincterotomy or dilation if needed, advances a guidewire across the stricture, and deploys a biliary stent to relieve obstruction. Post-procedure the patient is observed in the recovery area, monitored for complications (pancreatitis, bleeding, perforation, cholangitis), given post-procedure instructions, and scheduled for stent surveillance or exchange as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or routine service | When the procedure is performed as scheduled without complications or unusual effort |