CPT 43275: ERCP with Radiologic Assessment and Stent/Foreign Body Removal
CPT code 43275 defines an endoscopic retrograde cholangiopancreatography (ERCP) with radiologic assessment of the pancreatic duct and biliary tree and removal of one or more foreign bodies or stents. This procedure is clinically significant for diagnosing and treating biliary and pancreatic ductal disorders, including obstruction, retained stents, or migrated foreign bodies, and it frequently directs subsequent inpatient or outpatient management.
Key national payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent and care setting for the code, typical billing considerations, commonly applied modifiers, and how this service aligns with related endoscopic and radiologic procedures. The publication outlines benchmarks and payment context where available, highlights policy updates that affect coverage and prior authorization practices, and situates the code within clinical workflows for gastroenterology and interventional endoscopy teams.
This summary is intended to serve clinicians, billing professionals, and policy analysts seeking a national-level reference on the procedure definition, site-of-service implications, payer coverage landscape, and the operational and documentation points most relevant to claims and utilization review.
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Billing Code Overview
CPT code 43275 describes an endoscopic retrograde cholangiopancreatography (ERCP) procedure in which the physician inspects the duodenum and the papilla of Vater endoscopically, performs radiologic assessment of the pancreatic duct and biliary tree, and removes one or more foreign bodies or stents from the biliary or pancreatic ducts.
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Service type: Endoscopic diagnostic and therapeutic procedure involving combined endoscopy and fluoroscopic radiologic assessment with device/stent removal
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Typical site of service: Hospital-based endoscopy suite or ambulatory surgical center (procedures performed under endoscopic and radiologic guidance)
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of choledocholithiasis and prior biliary stent placement presents with right upper quadrant pain, jaundice, and abnormal liver function tests. Imaging (ultrasound or MRCP) demonstrates biliary ductal dilation and a likely migrated or occluded biliary stent. The gastroenterologist schedules an endoscopic retrograde cholangiopancreatography (ERCP) with planned removal of one or more foreign bodies or stents from the biliary tree.
Pre-procedure workflow includes pre-procedure evaluation (history, allergies, anticoagulation review), informed consent, and anesthesia planning (conscious sedation vs monitored anesthesia care/general anesthesia). During the procedure, a duodenoscope is advanced to the second portion of the duodenum, the ampulla (papilla of Vater) is cannulated, and contrast is injected for fluoroscopic assessment of the pancreatic duct and biliary tree. The physician locates the stent or foreign body and removes it using appropriate endoscopic devices (forceps, snares, retrieval balloons, or baskets). Fluoroscopic images document ductal anatomy and confirm complete removal. Post-procedure care includes recovery monitoring, assessment for complications (pancreatitis, bleeding, perforation, infection), and discharge instructions or inpatient admission if clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work required to remove impacted or multiple stents/foreign bodies is substantially greater than usual for 43275. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances before completion. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons for unusually complex removal. |
66 | Surgical team | Use when a surgical team is required for the procedure. |
78 | Unplanned return to the operating/procedure room for a related procedure during the postoperative period | Use if the patient requires an unplanned repeat ERCP for a complication of the initial procedure. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period. |
58 | Staged or related procedure during the postoperative period | Use when a planned additional ERCP is performed as part of a staged therapeutic plan. |
74 | Discontinued outpatient hospital/ambulatory surgery center procedure after anesthesia administration | Use when the procedure is aborted after anesthesia but before its completion. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an advanced practice provider performs assistant-at-surgery duties during 43275. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures where the anesthesiologist is medical director | Use when anesthesiology medical direction applies to the case. |
QX | CRNA service with medical direction by a physician | Use when a CRNA provides anesthesia with physician medical direction. |
QY | Medical direction of one certified registered nurse anesthetist by an anesthesiologist | Use when an anesthesiologist medically directs a CRNA. |
TC | Technical component | Use when billing only the technical (facility/technical) component of associated imaging or fluoroscopy equipment, if separated. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2086S0101X | Gastroenterologist | Gastroenterologists most commonly perform ERCP procedures and stent removals. |
207L00000X | General Surgeon | General surgeons with advanced endoscopy training may perform ERCP and complex ductal interventions. |
208000000X | Internal Medicine (Hospitalist with procedural skills) | Hospital-based internists may coordinate care and manage pre/post-procedure medical issues. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K80.50 | Calculus of bile duct without cholangitis or cholecystitis, unspecified | Common indication for ERCP and stent/stone removal. |
K83.1 | Obstruction of bile duct | Explains biliary dilation and need for removal of obstructing stent or foreign body. |
K83.0 | Cholangitis | Infection of the biliary tree may necessitate urgent ERCP with stent removal or exchange. |
T82.4XXA | Mechanical complication of other biliary prosthetic devices, initial encounter | Used when a biliary stent has migrated, occluded, or malfunctioned requiring removal. |
K85.1 | Biliary acute pancreatitis | Pancreatitis secondary to biliary obstruction or instrumentation may prompt ERCP for ductal evaluation and stent management. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
43260 | Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | May be performed prior to ERCP if diagnostic upper endoscopy is needed or to evaluate proximal GI tract anatomy. |
43264 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | May be performed in the same session if biopsy of duodenal lesion or ampullary tissue is required. |
43276 | Endoscopic retrograde cholangiopancreatography (ERCP) including endoscopic sphincterotomy, with removal or manipulation of pancreatic duct stones, stents, or other foreign bodies | Performed when therapeutic sphincterotomy is required in addition to stent removal; often billed alongside or as alternative ERCP therapeutic codes depending on services rendered. |
43278 | Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic retrograde biliary balloon dilation or other endoscopic biliary procedures | May be performed in conjunction with stent removal when ductal dilation or further biliary therapy is necessary. |
47562 | Laparoscopic cholecystectomy | May be performed before or after ERCP in the management of gallstone disease when cholecystectomy is indicated. |