Summary & Overview
HCPCS C7544: ERCP with Removal of Biliary/Pancreatic Calculi
HCPCS Level II code C7544 captures an advanced endoscopic procedure — endoscopic retrograde cholangiopancreatography (ERCP) with direct visualization and removal of calculi or debris from the biliary and/or pancreatic ducts, including endoscopic cannulation of the papilla. This procedure is clinically important for diagnosing and treating obstructive biliary or pancreatic conditions that can cause pain, infection, or pancreatitis, and it carries implications for utilization, facility billing, and procedural authorization nationwide.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for C7544, typical sites of service, common modifiers associated with complex endoscopic procedures, and gaps where data were not provided. The publication outlines expected billing workflows and payer considerations relevant to facility and professional service lines, highlighting where payer policy differences may affect prior authorization and payment adjudication.
This analysis serves clinicians, coding and billing professionals, and health policy stakeholders seeking a practical reference on the clinical meaning and billing implications of C7544. Data not available in the input will be identified explicitly in the relevant sections of the full publication.
Billing Code Overview
HCPCS Level II code C7544 describes endoscopic retrograde cholangiopancreatography (ERCP) with removal of calculi/debris from biliary/pancreatic duct(s), including endoscopic cannulation of the papilla with direct visualization of the pancreatic/common bile duct(s).
Service Type: Interventional endoscopic biliary/pancreatic procedure
Typical Site of Service: Hospital outpatient department or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents with right upper quadrant pain, jaundice, and elevated liver enzymes after imaging demonstrates common bile duct dilation and a suspected obstructing stone. The gastroenterology team schedules an endoscopic retrograde cholangiopancreatography (ERCP) with planned endoscopic cannulation of the papilla for direct cholangiopancreatography and removal of biliary calculi/debris (C7544). The procedure is performed in an ambulatory endoscopy suite or hospital endoscopy unit with monitored anesthesia care or general anesthesia depending on comorbidities. Pre-procedure workflow includes informed consent, review of coagulation status and anticoagulant management, NPO status, antibiotic prophylaxis as indicated, and verification of prior imaging. During the procedure, the endoscopist performs duodenoscopy, selectively cannulates the ampulla under direct visualization, injects contrast to opacify the common bile duct and/or pancreatic duct, removes stones and debris using baskets, balloons, or irrigation, and places ductal stents if needed. Immediate post-procedure monitoring evaluates respiratory status, bleeding, pancreatitis symptoms, and vital signs. Discharge instructions address signs of post-ERCP pancreatitis, infection, or perforation and specify follow-up for stent removal or further biliary management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |