HCPCS C7560: ERCP with Stent or Foreign Body Removal and Duct Visualization - OpenPayer

Summary & Overview

HCPCS C7560: ERCP with Stent or Foreign Body Removal and Duct Visualization

HCPCS Level II code C7560 represents an advanced endoscopic procedure: endoscopic retrograde cholangiopancreatography (ERCP) with removal of foreign body(s) or stent(s) from the biliary or pancreatic ducts, combined with endoscopic cannulation of the papilla and direct visualization of the pancreatic and common bile ducts. This code captures a therapeutic ERCP encounter where device removal and ductal inspection are central and often determines downstream care.

This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the payer landscape relevant to coverage and claims classification. The publication outlines expected billing considerations, common modifiers used with similar procedures (input provided), and where documentation typically aligns with the coded service.

Readers will learn how C7560 is used to represent combined removal and diagnostic visualization during ERCP, what clinical workflows commonly accompany the service (endoscopy suite in hospital outpatient or ambulatory surgical center), and which payers are commonly engaged for authorization and payment. Data not available in the input will be identified explicitly in specific sections of the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC7560HCPCS Level IIERCPendoscopybiliary ductpancreatic ductstent removalambulatory surgical centerhospital outpatient

Billing Code Overview

HCPCS Level II code C7560 describes endoscopic retrograde cholangiopancreatography (ERCP) with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) and endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s).

Service type: Therapeutic endoscopic biliary/pancreatic procedure involving device removal and duct visualization.

Typical site of service: Hospital outpatient department or ambulatory surgical center (endoscopy suite).

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a history of choledocholithiasis presents with acute right upper quadrant pain, jaundice, and elevated liver function tests. Imaging with transabdominal ultrasound and MRCP demonstrates dilation of the common bile duct and a retained biliary plastic stent from a prior procedure, as well as suspected filling defect consistent with a stone. The gastroenterology team schedules an endoscopic retrograde cholangiopancreatography procedure with planned endoscopic cannulation of the papilla, direct cholangiopancreatoscopic visualization of the biliary and/or pancreatic ducts, and removal of the retained stent and/or foreign body.

The clinical workflow includes pre-procedure evaluation (history, medication reconciliation, informed consent, coagulation assessment), procedural sedation or monitored anesthesia care, endoscopic cannulation of the ampulla of Vater, direct visualization of the biliary and/or pancreatic ducts using endoscopic imaging, extraction of the foreign body or stent using retrieval devices (eg, baskets, graspers), ductal clearance assessment, and post-procedure recovery with instructions and documentation of findings and devices removed. Typical intra-procedural documentation includes indication, technique (selective cannulation, cholangiopancreatoscopy), devices used, foreign body/stent characteristics, specimen or device disposition, complications, and planned follow-up.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

HCPCS C9113: Injection, Pantoprazole Sodium, Per Vial

HCPCS-C9449-BLINATUMOMAB-INJECTION-1-MCG

HCPCS C9449: Blinatumomab Injection, 1 mcg

HCPCS-C1758-URETERAL-CATHETER

HCPCS C1758: Ureteral Catheter, Urological Device

HCPCS-C1780-INTRAOCULAR-LENS-NEW-TECHNOLOGY

HCPCS C1780: Intraocular Lens, New Technology

HCPCS-LEVEL-II-C9300-INDIGOTINDISULFONATE-INJECTION-1MG

HCPCS Level II C9300: Injection, Indigotindisulfonate Sodium, 1 mg

HCPCS-C9029-GUSELKUMAB-INJECTION-1MG

HCPCS Level II C9029: Injection, guselkumab 1 mg

HCPCS-C2643-CESIUM-131-BRACHYTHERAPY-SOURCE-NON-STRANDED

HCPCS Level II C2643: Cesium-131 Brachytherapy Source, Non-Stranded

HCPCS-C1726-NON-VASCULAR-BALLOON-DILATATION-CATHETER

HCPCS C1726: Catheter, Balloon Dilatation, Non-Vascular

HCPCS-C9724-ENDOSCOPIC-FULL-THICKNESS-PLICATION-STOMACH-EPS

HCPCS C9724: Endoscopic Full-Thickness Plication of Stomach (EPS)

HCPCS-C8923-TRANSTHORACIC-ECHOCARDIOGRAPHY-CONTRAST-COMPLETE-2D

HCPCS C8923: Transthoracic Echocardiography with Contrast, Complete

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Taxonomy Code	Specialty	Notes
`207VC0100X`	Gastroenterology	Primary specialty performing diagnostic and therapeutic ERCP and cholangioscopy.
`207VS0102X`	Surgical Gastroenterology	Surgeons with advanced endoscopic training who perform therapeutic ERCP and complex ductal interventions.
`208000000X`	General Surgery	Surgeons who perform ERCP in some centers; may participate in complex endoscopic-surgical cases.
`363LA2200X`	Anesthesiology	Provides sedation, monitored anesthesia care, or general anesthesia for ERCP procedures.
`207K00000X`	Colorectal Surgery	Occasionally involved when combined endoscopic-surgical management is needed for complex biliary-pancreatic disease.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K80.5`	Calculus of bile duct without cholangitis	Common indication when choledocholithiasis requires endoscopic removal via ERCP and visualization.
`K83.1`	Obstruction of bile duct	Indicates biliary obstruction from strictures, stones, or migrated stents necessitating ERCP and foreign body/stent removal.
`K83.0`	Cholangitis	Infection of the biliary tree often requiring urgent ERCP for decompression and removal of obstructing material or stents.
`T83.198A`	Other mechanical complication of other specified prosthetic devices, implants and grafts, initial encounter	Used when a biliary stent malfunctions or migrates and requires endoscopic retrieval.
`K85.1`	Biliary pancreatitis	Pancreatitis secondary to biliary obstruction where ERCP with ductal visualization and stent/stone removal may be indicated.
`T18.1XXA`	Foreign body in alimentary tract, initial encounter	Applied when an ingested or iatrogenic foreign body is lodged in the biliary or pancreatic ducts and requires endoscopic removal.
`K91.2`	Postprocedural cholangitis	Used when infection occurs after prior biliary intervention and subsequent ERCP is required for management.

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; with endoscopic cannulation of the major papilla	Often performed as the diagnostic or initial ERCP entry step prior to therapeutic maneuvers such as stent removal.
`43262`	ERCP, with removal of stone(s) from biliary tract; with sphincterotomy	Performed when ductal stones are present and requires sphincterotomy for extraction; may be performed in the same session as stent removal.
`43264`	ERCP, with endoscopic retrograde removal of stent(s) from biliary tract	Directly related when stent removal is performed without additional complex cholangioscopy.
`43281`	Endoscopic retrograde cholangiopancreatography, with cannulation of the pancreatic duct; diagnostic	Used when selective cannulation and evaluation of pancreatic duct is required in addition to biliary work.
`43299`	Unlisted procedure, small intestine	Rarely used only when a specific CPT for the exact endoscopic visualization technique is not available; documentation must support unlisted reporting.
`45380`	Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate endoscopic procedure commonly performed during the same encounter if indicated)	May be performed in the same endoscopy session for concurrent lower GI evaluation as clinically indicated.

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