CPT 43275: ERCP with Radiologic Assessment and Stent/Foreign Body Removal - OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 43275ERCPendoscopybiliary ductpancreatic ductstent removalendoscopic retrograde cholangiopancreatographygastroenterologyambulatory surgery

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.

Service type: Endoscopic diagnostic and therapeutic procedure involving combined endoscopy and fluoroscopic radiologic assessment with device/stent removal
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

CPT 43270: Esophagogastroduodenoscopy with Dilation and Lesion Ablation

cpt-43277-ercp-with-balloon-dilation-pancreaticobiliary-ducts

CPT 43277: ERCP with Radiologic Assessment and Balloon Dilation

cpt-43278-ercp-endoscopic-ablation-biliary-pancreatic-ducts

CPT 43278: ERCP with Ablation of Biliary or Pancreatic Lesions

cpt-43273-ercp-visualization-pancreatic-common-bile-ducts

CPT 43273: ERCP Visualization of Pancreatic or Common Bile Ducts

cpt-43261-ercp-with-biopsy-diagnostic-endoscopy-biliary-pancreatic-imaging

CPT 43261: ERCP Diagnostic Endoscopy with Biliary/Pancreatic Biopsy

cpt-43260-diagnostic-ercp-upper-endoscopy-biliary-contrast

CPT 43260: Diagnostic ERCP with Upper Endoscopy and Biliary Contrast

cpt-43264-ercp-endoscopy-ductal-stone-removal

CPT 43264: ERCP Upper Endoscopy with Ductal Contrast and Stone Removal

cpt-43265-ercp-therapeutic-pancreaticobiliary-stone-destruction

CPT 43265: ERCP with Pancreaticobiliary Evaluation and Stone Destruction

cpt-43274-ercp-biliary-or-pancreatic-duct-stent-placement

CPT 43274: ERCP with Biliary or Pancreatic Duct Stent Placement

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CPT 43262: ERCP with Sphincterotomy or Papillotomy

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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.

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