2025 CPT code 43260
(Active) Effective Date: N/A Revision Date: N/A Diagnostic - Endoscopy Digestive System Feed
Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or without specimen collection.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., modifier 51 for multiple procedures, modifier 59 for distinct procedural services).
Medical necessity for ERCP is established by clinical symptoms and findings suggesting biliary or pancreatic pathology, such as jaundice, abdominal pain, elevated liver enzymes, or pancreatitis.
A gastroenterologist or other qualified physician performs this procedure.Responsibilities include inserting the endoscope, navigating the biliary and pancreatic ducts, injecting contrast material, collecting samples (if needed), interpreting the images, and documenting the findings.
In simple words: This test uses a thin, flexible tube with a camera (endoscope) to look at the bile ducts and pancreas. A special dye is injected to help create X-ray images, showing if there are any problems. Sometimes, small samples are taken for testing.
Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic procedure that combines upper endoscopy with retrograde injection of contrast material into the biliary ducts to obtain fluoroscopic images of the gallbladder, pancreas, and bile ducts.Specimen collection by brushing or washing may also be performed.The procedure involves passing an endoscope through the mouth into the duodenum and then into the biliary tract. A catheter injects contrast material into the pancreatic and biliary ducts to visualize the structures.The procedure is considered complete if one or more ductal systems (pancreatic/biliary) are visualized.This code does not include therapeutic procedures such as stent placement or stone removal.
Example 1: A 55-year-old female presents with abdominal pain and jaundice.ERCP is performed to evaluate for biliary obstruction.The procedure reveals a common bile duct stone, which is not removed during this diagnostic procedure., A 70-year-old male with a history of pancreatitis undergoes ERCP to assess the patency of the pancreatic duct. The procedure demonstrates a stricture, prompting further evaluation., A 40-year-old female with recurrent cholangitis undergoes ERCP to evaluate for underlying biliary pathology.Brushings are obtained for cytology.
Complete patient history and physical examination, indication for the procedure, informed consent, images from fluoroscopy, procedural notes describing the cannulation and visualization of the pancreatic and/or biliary ducts, pathology reports if specimens were obtained.
** Imaging of the ductal systems (with images saved and reported) may be separately coded using codes 74328, 74329, or 74330.
- Payment Status: Active
- Modifier TC rule: Not applicable
- Specialties:Gastroenterology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center