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.
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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 |
22 | Increased procedural services | When documentation supports substantially greater work or complexity than typical for 43274 |
52 | Reduced services | When the procedure is partially reduced or not completed as originally planned but still performed |
53 | Discontinued procedure | When the procedure is started but halted due to extenuating circumstances or patient condition |
59 | Distinct procedural service | When another distinct procedure is performed on the same day and documentation supports separate services |
62 | Two surgeons | When two surgeons work together as co-surgeons with documented shared duties (rare for ERCP) |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | When the patient requires an unplanned repeat endoscopic procedure for a related complication during the global period |
74 | Return to the operating/procedure room after discontinuation during the postoperative period | When a previously discontinued ERCP is repeated during the postoperative period |
26 | Professional component | When reporting only the physician professional component separate from technical component of imaging/fluoroscopy (use of TC for technical) |
TC | Technical component | When reporting only the facility/technical component for fluoroscopic imaging or equipment use |
59 | Distinct procedural service | Use to indicate a separate and distinct procedure on the same day (listed for emphasis; ensure appropriate use) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208100000X | Gastroenterology | Most common specialty performing ERCP and stent placement |
| 207T00000X | Surgical Gastroenterology | Surgeons specializing in complex biliary/pancreatic endoscopy |
| 363L00000X | Interventional Radiology | May be involved in percutaneous biliary drainage as an alternative or adjunct |
| 2084P0800X | Advanced Endoscopist | Physicians with advanced endoscopy training who perform therapeutic ERCP |
| 261QE0800X | Anesthesiology | Provides monitored anesthesia care or general anesthesia for high-risk patients |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K83.1 | Obstruction of bile duct | Common indication for ERCP with stent placement to relieve biliary obstruction |
K80.30 | Calculus of bile duct without cholangitis or obstruction, unspecified | Choledocholithiasis may require ERCP for stone extraction and possible stenting |
K83.0 | Cholangitis | Acute cholangitis often necessitates urgent ERCP for decompression and stent placement |
C24.1 | Malignant neoplasm of extrahepatic bile ducts | Malignant biliary strictures frequently require ERCP with stent insertion for palliation |
K86.1 | Other chronic pancreatitis | Pancreatic duct strictures or leaks in chronic pancreatitis may require ERCP and pancreatic stenting |
K85.1 | Biliary acute pancreatitis | When caused by biliary obstruction, ERCP with sphincterotomy and stent may be therapeutic |
K91.2 | Postprocedural cholangitis | May be coded for complications related to biliary procedures and subsequent ERCP management |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
43274 | Endoscopic retrograde cholangiopancreatography, with endoscopic stent placement in the biliary or pancreatic duct(s) | Primary procedure for biliary or pancreatic duct decompression and stent placement |
43260 | Endoscopic retrograde cholangiopancreatography, diagnostic, with or without collection of specimen(s) by brushings or washings (separate procedure) | Often performed prior to or during therapeutic ERCP to evaluate ductal anatomy and obtain specimens |
43262 | Endoscopic retrograde cholangiopancreatography, with sphincterotomy and/or dilation of papilla, with or without stent placement | Performed when sphincterotomy or dilation is required to facilitate stone extraction or stent placement; may precede 43274 in the same session |
47560 | Laparoscopic cholecystectomy | May be performed before or after ERCP in patients with gallstone disease; part of combined management strategies |
47562 | Laparoscopic cholecystectomy with exploration of common bile duct | Performed when intraoperative common bile duct exploration is indicated; alternative to endoscopic management in some cases |
43278 | Endoscopic retrograde cholangiopancreatography with removal of biliary or pancreatic duct stent | Performed during follow-up procedures to remove or exchange previously placed stents |