2025 CPT code 43264
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Endoscopic retrograde cholangiopancreatography (ERCP) with removal of calculi/debris from biliary/pancreatic duct(s).
Modifiers may be applicable, such as modifier 59 to indicate a distinct procedural service.Modifier 59 may be used when 43264 is performed in conjunction with stent placement, removal, or replacement during the same session (to indicate that the stone removal is distinct and separate from stent-related work). Use modifier XS when the stones are extracted from different locations within the biliary system.
Medical necessity for 43264 must be supported by documentation of signs and symptoms related to biliary or pancreatic duct obstruction, such as jaundice, abdominal pain, abnormal liver function tests, or imaging findings suggestive of calculi or debris.
In simple words: This procedure removes blockages like stones or debris from the bile and pancreatic ducts using a thin, flexible tube with a camera and light. The doctor inserts the tube through your mouth, and real-time X-rays help guide the tools to remove the blockage.
This code describes a procedure where an endoscope is used to visualize and remove stones or debris from the biliary and/or pancreatic ducts.It involves passing a scope through the mouth, down the esophagus, and into the duodenum to access the bile and pancreatic ducts. Fluoroscopy (X-ray imaging) is used to guide the procedure. Instruments passed through the endoscope are then used to remove stones or debris. This code includes any method used to remove the debris.
Example 1: A patient presents with jaundice and abdominal pain.ERCP reveals multiple stones in the common bile duct.Code 43264 is used to report the removal of these stones., During an ERCP, a patient is found to have a blockage of the pancreatic duct caused by debris and small stones. The physician successfully removes the blockage using various instruments.Code 43264 is reported., A patient has undergone previous ERCP with stent placement. The stent has now migrated and caused obstruction.During a repeat ERCP, the stent is removed (43275), and residual stones are found and removed.Code 43264 and 43275 with modifier 59 would be used.
Documentation should support the medical necessity of the ERCP and clearly describe the findings, including the location and type of calculi/debris removed. The report should also detail the methods used for removal.If fluoroscopic guidance is used, it should be documented. If moderate sedation is used, it must be documented and coded separately.
- Specialties:Gastroenterology, General Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient