2025 CPT code 43263
Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Measurement of sphincter of Oddi pressure during ERCP.
Modifiers may be applicable to 43263 in certain circumstances, such as modifier 59 (distinct procedural service) if performed in conjunction with other ERCP procedures during the same session. Modifier 74 (discontinued outpatient procedure after anesthesia) may also apply if appropriate. Always check payer guidelines for appropriate modifier usage.
Medical necessity for 43263 is established when there is a clinical suspicion of sphincter of Oddi dysfunction or other biliary or pancreatic conditions requiring assessment of sphincter function. Symptoms such as abdominal pain, abnormal liver tests, or recurrent pancreatitis may warrant this procedure.
After anesthesia, the physician inserts an endoscope through the patient's mouth to the duodenum. A catheter is advanced through the endoscope into the biliary tract, and contrast material is injected to visualize the ducts under fluoroscopy. A manometry catheter is then used to measure sphincter of Oddi pressure. Findings are recorded on a computer. The physician is responsible for interpreting the images and pressure measurements to diagnose biliary and pancreatic disorders.
In simple words: This procedure measures the pressure of the muscle that controls the flow of digestive juices into the small intestine. A thin, flexible tube with a camera is inserted through the mouth and down to the small intestine. Then, a special catheter is used to measure the pressure of the sphincter of Oddi muscle.
Endoscopic retrograde cholangiopancreatography (ERCP) with pressure measurement of the sphincter of Oddi (pancreatic duct or common bile duct). This involves passing a scope through the mouth into the duodenum, accessing the biliary tract, and using a manometry catheter to measure the pressure required to open the sphincter of Oddi. The pressure readings are recorded on a computerized device.
Example 1: A patient with suspected sphincter of Oddi dysfunction undergoes ERCP with manometry to assess sphincter function and guide treatment decisions., A patient with recurrent pancreatitis of unknown origin undergoes ERCP with manometry to evaluate for sphincter of Oddi dysfunction as a potential cause. , A patient with abdominal pain and abnormal liver tests undergoes ERCP with sphincter of Oddi manometry to investigate the cause of the symptoms.
Documentation should include the indication for the procedure, findings from the ERCP including visualization of the ducts and any abnormalities, sphincter of Oddi manometry measurements, interpretation of the findings, and any interventions performed during the procedure.
- RVU:
- Payment Status: Active
- Specialties:Gastroenterology, General Surgery
- Place of Service:Ambulatory Surgical Center, Hospital-Inpatient, Hospital-Outpatient