Summary & Overview

CPT 47552: Endoscopic Diagnostic Examination of Biliary Tract

CPT code 47552 denotes an endoscopic diagnostic examination of the biliary tract, inclusive of specimen collection by brushing or washing when performed. This code captures a focused diagnostic procedure used to evaluate biliary pathology such as obstructive symptoms, suspected strictures, or biliary leaks. Nationally, accurate coding for this procedure supports appropriate clinical documentation, resource allocation, and billing for endoscopy services in both hospital-based and outpatient endoscopy settings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary outlines payer coverage patterns and coding considerations relevant across commercial and public programs but does not provide plan-specific reimbursement rates.

Readers will learn the clinical context in which CPT code 47552 is used, common service settings, and the types of documentation elements that typically accompany biliary endoscopic diagnostics. The publication also highlights national benchmarks and policy updates affecting endoscopic biliary procedures where available. Data not available in the input will be noted in the detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare47552CPTbiliary endoscopyendoscopic diagnostic proceduregastroenterologyendoscopyspecimen collectionhospital outpatientclinical coding

Billing Code Overview

CPT code 47552 describes an endoscopic diagnostic examination of the biliary tract. The procedure uses an endoscope to directly visualize the bile ducts and the biliary tree; collection of one or more specimens by brushing or washing is included in this code.

Service type: Endoscopic diagnostic biliary tract procedure
Typical site of service: Hospital-based endoscopy suite or outpatient endoscopy center

Clinical & Coding Specifications

Clinical Context

A 62-year-old female with a history of cholelithiasis and intermittent right upper quadrant pain presents with progressive jaundice and abnormal liver function tests showing cholestatic pattern. Imaging (abdominal ultrasound and MRCP) demonstrates intrahepatic bile duct dilation and a possible distal common bile duct stricture. The gastroenterologist schedules an endoscopic retrograde cholangiopancreatography (ERCP) with diagnostic cholangiography and biliary brushings/washings to evaluate for malignant obstruction vs benign stricture.

The procedure is performed in an endoscopy suite or hospital outpatient operating room under moderate sedation or monitored anesthesia care. The provider advances a duodenoscope to the second portion of the duodenum, cannulates the ampulla, and injects contrast to visualize the biliary tree. Diagnostic cholangiography is completed; brushings and/or biliary washings are obtained for cytology as indicated. Specimens are submitted to pathology. The patient is recovered in the post-procedure area and discharged or admitted based on findings and clinical status.

Typical site of service: hospital outpatient department (endoscopy unit) or ambulatory surgery center. Service type: diagnostic endoscopic biliary evaluation with collection of biliary cytology (brushings/washings) as described by code 47552.

Coding Specifications

Modifier	Description	When to Use
`52`

Taxonomy Code	Specialty	Notes
`330600000X`	Gastroenterology	Most common specialty performing diagnostic ERCP/ biliary endoscopy.
`207RG0300X`	General Surgery	Surgeons with advanced endoscopy training may perform biliary endoscopy in some settings.
`208000000X`	Colon & Rectal Surgery (advanced endoscopists)	Some colorectal surgeons with upper endoscopy credentialing perform ERCP in select centers.
`363LP0800X`	Interventional Radiology (note)	Interventional radiologists perform percutaneous cholangiography/ drainages as alternative biliary diagnostics.

ICD-10 Code	Description	Clinical Relevance
`K80.20`	Calculus of gallbladder without cholecystitis without obstruction	Gallstones may cause biliary colic and influence evaluation of the biliary tree with diagnostic cholangiography.
`K80.50`	Calculus of bile duct without cholangitis or cholecystitis	Common indication for biliary imaging and brushings if suspicion for ductal stones or residual stones.
`K83.1`	Obstruction of bile duct	Direct indication for diagnostic biliary evaluation to define level and cause of obstruction.
`K83.0`	Cholangitis	Acute or chronic biliary infection prompting imaging and possibly sampling for microbiology and cytology.
`C24.0`	Malignant neoplasm of extrahepatic bile duct	Suspicion of cholangiocarcinoma often leads to ERCP with cholangiography and brushings/washings for cytology.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43260`	Esophagogastroduodenoscopy, flexible, transoral; with diagnostic cholangiography, with or without collection of specimens by brushing or washing	Performed when upper endoscopy includes cannulation and diagnostic cholangiography; overlaps with biliary diagnostic endoscopy in some coding schemas.
`43262`	Esophagogastroduodenoscopy, flexible, transoral; with endoscopic retrograde cholangiopancreatography (ERCP) with cholangiography	ERCP codes for diagnostic/therapeutic biliary evaluation often reported alongside or instead of pure biliary diagnostic codes depending on documentation and whether sphincterotomy or stent placement is performed.
`43263`	ERCP, diagnostic, with or without collection of specimens by brushing or washing	Commonly billed for diagnostic ERCP procedures involving biliary evaluation and cytology collection; relates directly to `47552` as alternative coding in upper endoscopy family.
`47562`	Laparoscopic cholecystectomy; diagnostic cholangiography during cholecystectomy	If intraoperative cholangiography is performed during cholecystectomy, this code is used rather than an endoscopic biliary diagnostic code.
`43264`	ERCP with sphincterotomy and/or therapeutic intervention	Represents therapeutic escalation when ductal stones or strictures require intervention beyond diagnostic sampling; may follow or replace `47552` if therapy is performed.

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