CPT 43276: ERCP with Single Duct Stent Removal and Exchange
CPT code 43276 denotes an endoscopic retrograde cholangiopancreatography (ERCP) with radiologic evaluation of the pancreatic and biliary ducts that also includes removal and exchange of a single duct stent. This procedure is a combined diagnostic and therapeutic endoscopic service used to evaluate ductal anatomy and manage biliary or pancreatic stents. Nationally, ERCP with stent exchange is a commonly billed interventional gastroenterology service with implications for facility resource use, imaging support, and specialty physician time.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the clinical context for use in biliary and pancreatic duct management, and typical sites of service. The publication provides benchmarks and payer coverage considerations, coding guidance highlights, and notes on clinical documentation elements relevant to claims processing. Policy updates affecting ERCP coding and reimbursement trends for endoscopic stent procedures are summarized to inform billing, compliance, and revenue cycle stakeholders. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 43276 describes an endoscopic retrograde cholangiopancreatography (ERCP) procedure that includes endoscopic inspection of the duodenum and the papilla of Vater with radiologic assessment of the pancreatic duct and biliary tree, combined with removal and exchange of a single duct stent.
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Service type: Endoscopic diagnostic and therapeutic procedure involving the pancreatic and biliary ducts, including stent management
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Typical site of service: Hospital outpatient department or ambulatory surgery center where endoscopic, fluoroscopic, and interventional services are provided
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of choledocholithiasis and prior placement of a biliary plastic stent presents with recurrent right upper quadrant pain, abnormal liver function tests, and cholestatic pattern on labs. The gastroenterologist schedules an endoscopic retrograde cholangiopancreatography with planned removal and exchange of the existing single biliary duct stent. The procedure is performed in an outpatient endoscopy suite under monitored anesthesia care. The endoscopist advances a side-viewing duodenoscope to the second portion of the duodenum, locates the ampulla of Vater, cannulates the common bile duct, performs cholangiography to evaluate the biliary tree, removes the indwelling plastic stent, and places a new single duct stent. Fluoroscopic imaging documents ductal anatomy and stent position. Post-procedure the patient is recovered in the PACU with monitoring for complications (pancreatitis, bleeding, perforation, infection) and given discharge instructions for symptoms warranting return. Documentation elements include indication, informed consent, anesthesia type, endoscopic findings, radiologic interpretation, stent details (size, type, location), therapeutic maneuvers, and post-procedure condition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure requires substantially greater effort or complexity than typical and documentation supports increased work. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned but still performed in part. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances or those that threaten patient well-being. |
59 | Distinct procedural service | Use when ERCP with stent exchange is performed on a separate anatomic site or at a separate session distinct from another procedure. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons during the procedure. |
76 | Repeat procedure by same physician | Use when the same physician repeats the ERCP during the same operative session. |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Use if the patient requires an unplanned return to the procedure room for a related intervention. |
91 | Repeat clinical diagnostic laboratory test | Use when repeat laboratory tests are billed and pertinent to the procedure monitoring. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an advanced practice provider acts as assistant during the procedure per payer policy. |
52 | Reduced services | Use when parts of the ERCP (e.g., stent exchange) are intentionally omitted; documentation must support reduction. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207VG0200X | Gastroenterology | Gastroenterologists commonly perform diagnostic and therapeutic ERCP including stent exchange. |
208800000X | General Surgery | Surgeons with advanced endoscopy training may perform ERCP in operative settings. |
363LP0808X | Radiology - Interventional Radiology | Interventional radiologists perform percutaneous biliary interventions; they may be involved when ERCP is unsuccessful. |
363A00000X | Anesthesiology | Provides monitored anesthesia care or general anesthesia for complex ERCP cases. |
364S00000X | Nursing — Endoscopy | Endoscopy nursing staff support procedure workflow and documentation. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K80.1 | Calculus of bile duct with cholangitis | Choledocholithiasis with infection commonly prompts ERCP for stone removal and stent exchange to decompress the biliary tree. |
K80.50 | Calculus of bile duct without cholangitis, unspecified | Bile duct stones causing obstruction may require ERCP with stent exchange if prior stent was placed or if duct decompression is needed. |
K83.1 | Obstruction of bile duct | Mechanical obstruction from strictures or stones is an indication for ERCP and stent placement/exchange to restore biliary drainage. |
K83.0 | Cholangitis | Acute cholangitis often requires urgent ERCP for decompression and stent management. |
K85.9 | Acute pancreatitis, unspecified | ERCP is performed selectively when pancreatitis is due to biliary obstruction; prior stent exchange may be part of management when indicated. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
43260 | Endoscopic retrograde cholangiopancreatography, diagnostic, with or without collection of specimen(s) by brushing or washing when performed (without sphincterotomy or stent) | Diagnostic ERCP may be performed prior to therapeutic maneuvers; used when no sphincterotomy or stent placement is done. |
43262 | Endoscopic retrograde cholangiopancreatography, with transendoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and/or stone extraction | Performed when biliary sphincterotomy or stone extraction is required in addition to stent management. |
43274 | Endoscopic retrograde cholangiopancreatography, with insertion of indwelling stent(s) | Codes the placement of stents; 43276 specifically describes removal and exchange of a single duct stent, while 43274 may apply when placing new indwelling stents. |
43278 | Endoscopic retrograde cholangiopancreatography, with removal of impacted biliary stone, biliary stent, or other foreign body | Used when more complex removal of impacted material or multiple stents/foreign bodies is required beyond a single-stent exchange. |
43279 | Endoscopic retrograde cholangiopancreatography, with pancreatography, injection for chronic pancreatic ductal conditions | May be used when significant pancreatic duct evaluation or intervention is performed during the ERCP in addition to biliary stent management. |