2025 CPT code 43278
Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Endoscopic retrograde cholangiopancreatography (ERCP) with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed.
Modifiers may be applicable, particularly modifier 59 when multiple lesions are ablated in separate locations or separate procedures are performed during the same session.
Medical necessity should be established by documenting the patient's diagnosis, symptoms, and the clinical rationale for performing the ERCP with ablation. This typically includes imaging evidence of the lesion and pre-procedure assessment indicating it's amenable to endoscopic ablation.
The physician performs the ERCP procedure, which involves navigating the endoscope through the digestive tract to the targeted area, performing the ablation of the lesion(s), and managing any necessary dilation of the ducts.
In simple words: This procedure involves inserting a thin, flexible tube with a camera and light through your mouth to reach the ducts in your liver and pancreas.During the procedure, any abnormal growths like tumors or polyps are removed or destroyed.The doctor may also widen the ducts to make it easier to access and treat the affected areas.
This code describes a procedure where an endoscope is inserted through the mouth and advanced to the duodenum to access the biliary and pancreatic ducts. During the procedure, tumors, polyps, or other lesions are ablated (destroyed or removed).This includes any necessary dilation of the ducts before and after the ablation, and the use of a guidewire to facilitate access and instrument placement.
Example 1: A patient with a bile duct tumor discovered during imaging undergoes ERCP with ablation (43278) for treatment., A patient with a pancreatic duct polyp undergoes ERCP with ablation (43278), including pre-dilation due to a stricture., A patient with multiple small lesions in the biliary tree undergoes ERCP with ablation (43278) of all identified lesions during the same session.
Documentation should include details of the ERCP procedure, including the location and type of lesion(s) ablated, any dilation performed, guidewire usage, and any complications encountered. Pre- and post-procedure imaging reports are crucial.
- Revenue Code: P8B
- Specialties:Gastroenterology
- Place of Service:Ambulatory Surgical Center, Hospital-Outpatient, Inpatient Hospital