2025 CPT code 43275
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Endoscopic retrograde cholangiopancreatography (ERCP) with removal of one or more foreign bodies or stents from the biliary/pancreatic ducts.
Modifiers may be applicable depending on the circumstances of the procedure.For example, modifier 59 might be used if multiple stents were removed during the same session.Appropriate modifier selection should follow guidelines in the CPT manual.
Medical necessity for this procedure is established when a retained foreign body or stent causes symptoms (e.g., biliary obstruction, pancreatitis) or poses a risk of complications.
The physician performs the endoscopic procedure, including passing the endoscope, visualizing the ducts, and removing foreign bodies or stents.
In simple words: ERCP is a procedure where a thin, flexible tube with a camera is used to examine the bile and pancreatic ducts.During the procedure, the doctor removes any foreign objects or stents found in these ducts.
Endoscopic retrograde cholangiopancreatography (ERCP) involves endoscopic inspection of the duodenum and papilla of Vater, followed by radiologic assessment of the pancreatic and biliary trees.The procedure includes the removal of one or more foreign bodies (excluding calculi) or stents from the biliary or pancreatic ducts.The physician passes an endoscope through the oropharynx, esophagus, stomach, and into the small intestine for direct visualization of the pancreatic and/or common bile ducts. Removal of the foreign bodies or stents is then performed.
Example 1: A patient presents with a retained biliary stent after a previous cholecystectomy.The physician performs an ERCP to remove the stent.Code 43275 is reported., A patient with a history of pancreatitis has a retained pancreatic stent.An ERCP is performed, and the stent is removed.Code 43275 is used., During a routine ERCP for biliary stones, a plastic stent is found lodged in the common bile duct.The physician uses a snare to remove the stent; 43275 is reported.
* Operative report detailing the endoscopic procedure.* Preoperative and postoperative diagnoses.* Images of the biliary and pancreatic ducts (before and after stent removal).* Description of the removed foreign body or stent.
** Always ensure complete and accurate documentation to support the medical necessity and proper coding of this procedure.This is crucial for avoiding denials and ensuring timely reimbursement.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier may apply depending on the practice's billing structure and whether a separate professional component (26) is reported.
- Specialties:Gastroenterology, Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)