Summary & Overview
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.
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. |