2025 CPT code 43265
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Endoscopic retrograde cholangiopancreatography (ERCP) with destruction of calculi using any method (mechanical, electrohydraulic, lithotripsy).
Modifiers may be applicable in certain scenarios, such as multiple procedures (modifier 51), or when the procedure is performed on separate structures (modifier 59).Consult CPT guidelines for appropriate modifier use.
Medical necessity is established by the presence of symptomatic biliary or pancreatic stones obstructing the flow of bile or pancreatic secretions.Clinical findings (e.g., jaundice, abdominal pain, elevated liver function tests) and imaging studies (e.g., ultrasound, CT scan, MRCP) demonstrating biliary or pancreatic duct obstruction must be documented.
A gastroenterologist or other qualified physician performs this procedure.Responsibilities include: passing the endoscope, cannulating the ducts, injecting contrast material, identifying stones, performing stone destruction and removal, and interpreting the images.
In simple words: This procedure uses a thin, flexible tube with a camera (endoscope) to view the bile ducts and pancreas.If stones are found, they are broken up and removed using different methods, such as lasers or small instruments.
Endoscopic retrograde cholangiopancreatography (ERCP) involves endoscopic inspection of the duodenum and papilla of Vater, followed by radiological assessment of the pancreatic and biliary ducts.The procedure includes the destruction of calculi (stones) using any method, such as mechanical, electrohydraulic, or lithotripsy.Stone removal or debris extraction is inherent to this code and is not separately reported.
Example 1: A patient presents with jaundice and elevated bilirubin levels. Imaging reveals a large stone obstructing the common bile duct. An ERCP with lithotripsy is performed to fragment and remove the stone, resolving the patient's symptoms., A patient with recurrent pancreatitis undergoes ERCP to determine the cause. Multiple small stones are found in the pancreatic duct.ERCP with mechanical stone removal is performed.The patient's pain is significantly improved., A patient with a history of gallstones presents with acute cholecystitis.An ERCP is performed with electrohydraulic lithotripsy to remove impacted stones. Post-procedure, the patient experiences resolution of pain and inflammation.
* Pre-procedure imaging (e.g., ultrasound, CT scan) showing the location and size of the stones.* Operative report detailing the approach, instruments used, and the methods of stone destruction.* Documentation of stone removal, if applicable.* Post-procedure imaging to confirm the stone removal and duct patency.* Relevant patient history and physical examination findings.
** This code may be reported with other codes, depending on the procedures performed. For example, if sphincterotomy is performed, code 43262 may be reported separately.Always refer to the official CPT manual and NCCI edits for the most up-to-date and accurate coding guidelines.Specific payer policies should be verified before submitting claims.
- Revenue Code: P8B (Endoscopy - Upper Gastrointestinal)
- RVU: The relative value units (RVUs) for this code vary based on geographic location, facility type, and other factors.Consult the appropriate fee schedule for current values.
- Global Days: The global period is not applicable to this procedure.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not applicable to this code.
- Fee Schedule: Historical fee schedules vary significantly by year, location, and payer.Information on historical fee schedules can be found in archival sources for Medicare and other payers.
- Specialties:Gastroenterology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center