2025 CPT code 43277
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Endoscopic retrograde cholangiopancreatography (ERCP) with balloon dilation of a duct or the ampulla (sphincter of Oddi); includes sphincterotomy when performed.
Modifiers may be needed depending on the circumstances, such as modifier 59 for multiple dilations or other distinct procedural services.
Balloon dilation is medically necessary to relieve biliary or pancreatic duct obstruction, improve drainage, and alleviate associated symptoms.The procedure is indicated when conservative management has failed or when symptoms are severe.
A gastroenterologist or surgeon performs this procedure.Responsibilities include endoscopic visualization of the biliary and pancreatic ducts, balloon dilation of a stricture or ampulla, and potentially sphincterotomy.
In simple words: ERCP is a procedure where a thin, flexible tube with a camera is inserted into the body to examine the bile and pancreatic ducts.If there's a blockage, a small balloon is used to widen the duct. If needed, a small cut is also made.
Endoscopic retrograde cholangiopancreatography (ERCP) with balloon dilation of a duct or the ampulla (sphincter of Oddi), including sphincterotomy if performed.This procedure involves endoscopic inspection of the duodenum and papilla of Vater, followed by radiologic assessment of the pancreatic and biliary ducts. Balloon dilation is used to enlarge a blocked duct or the sphincter.The procedure may include the passage of guide wires.
Example 1: A patient presents with a bile duct stricture causing jaundice and elevated liver enzymes. ERCP with balloon dilation is performed to relieve the obstruction., A patient with recurrent pancreatitis due to a pancreatic duct stricture undergoes ERCP with balloon dilation to improve pancreatic drainage., A patient with symptomatic choledocholithiasis (gallstones in the common bile duct) undergoes ERCP with stone removal.During the procedure, a sphincterotomy and balloon dilation are performed to facilitate stone extraction.
* Pre-procedure imaging (e.g., ultrasound, CT scan, MRCP) showing the location and extent of the stricture or obstruction.* Informed consent.* Intraoperative fluoroscopic images documenting the procedure.* Post-procedure imaging to assess the effectiveness of the dilation.* Pathology report (if tissue is obtained).* Operative report detailing the procedure performed, including the size of the balloon and the location of the dilation.
** This code includes the use of balloon dilation in the biliary and pancreatic systems.It also includes sphincterotomy when performed concurrently.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier may apply depending on the payer and the services provided by the physician versus other healthcare professionals.
- Specialties:Gastroenterology, Surgery
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center