2025 CPT code 43262
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy/papillotomy.
Modifiers may be applicable in certain situations, such as for multiple procedures (51), distinct procedural service (59), or reduced services (52). Refer to current CPT guidelines for appropriate modifier usage.
Medical necessity for 43262 must be supported by documentation of a clinically significant condition requiring intervention, such as biliary or pancreatic duct obstruction, sphincter of Oddi dysfunction, or removal of stones or debris.
The physician performs the ERCP procedure, which includes inserting the endoscope, accessing the bile and pancreatic ducts, and performing the sphincterotomy/papillotomy. This requires specialized training and expertise in endoscopic procedures.
In simple words: This procedure involves using a thin, flexible tube with a camera to view the bile and pancreatic ducts and then making a small cut to open up a narrowed or blocked area where these ducts empty into the intestines.
This code represents an endoscopic retrograde cholangiopancreatography (ERCP) performed with a sphincterotomy and/or papillotomy.ERCP involves inserting an endoscope through the mouth, down the esophagus, and into the duodenum to visualize and access the bile and pancreatic ducts. A sphincterotomy is an incision made to widen the sphincter of Oddi (which controls the flow of bile and pancreatic juices into the small intestine), while a papillotomy involves an incision of the major duodenal papilla (the point where the bile and pancreatic ducts enter the duodenum).
Example 1: A patient presents with jaundice and abdominal pain. Imaging reveals a gallstone lodged in the common bile duct causing an obstruction. An ERCP with sphincterotomy (43262) is performed to remove the stone and relieve the obstruction., A patient with recurrent pancreatitis is suspected to have sphincter of Oddi dysfunction. An ERCP with sphincterotomy (43262) is performed to enlarge the opening and improve drainage., A patient with a history of pancreatic cancer develops jaundice. An ERCP with sphincterotomy (43262) is performed to relieve the obstruction and improve biliary drainage.
Documentation should include the indication for the procedure, details of the ERCP findings (e.g., location and size of stones, strictures), the type of sphincterotomy/papillotomy performed, and any complications encountered.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- Specialties:Gastroenterology, General Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient