2025 CPT code 43273
(Active) Effective Date: N/A Revision Date: N/A Surgery - Endoscopic Retrograde Cholangiopancreatography (ERCP) Procedures Surgery Feed
Endoscopic cannulation of the papilla with direct visualization of the pancreatic and/or common bile duct(s).
Modifiers 22, 26, 52, 53, 59, and 76 may be applicable depending on the specific circumstances of the procedure.Proper documentation is crucial for modifier selection.
Medical necessity is established by the presence of a clinical indication for direct visualization of the pancreatic or common bile duct, such as suspected stones, strictures, tumors, or other abnormalities not adequately assessed by standard fluoroscopy. This direct visualization helps guide subsequent treatment.
The clinical responsibility involves cannulating the papilla and directly visualizing the pancreatic and/or common bile duct(s) using an endoscope. This requires expertise in endoscopic techniques and interpretation of anatomical structures.
In simple words: The doctor uses a thin tube (cannula) to look directly at the bile and/or pancreatic ducts inside the body.This is done after an initial procedure to view these ducts, using x-rays. This code is only used along with another code showing that the initial procedure was done.
This CPT code, 43273, represents endoscopic cannulation of the papilla, achieved through the insertion of a cannula into the papilla of Vater, followed by direct visualization of one or more pancreatic and/or common bile ducts. This procedure is considered an add-on code and must be reported in addition to the primary ERCP code (43260-43265 or 43274-43278), reflecting the additional work involved in achieving direct visualization beyond standard fluoroscopy.
Example 1: A patient presents with suspected choledocholithiasis (gallstones in the common bile duct).After performing a diagnostic ERCP (43260), the physician uses a cholangioscope to directly visualize the common bile duct to confirm the presence and number of stones, guiding subsequent stone removal procedures., A patient undergoes an ERCP for suspected pancreatic duct stricture. Following sphincterotomy (43262) and cannulation, the physician uses a cholangioscope to directly visualize the pancreatic duct to assess the stricture's location, length, and severity, guiding subsequent dilation or stent placement., During an ERCP for suspected biliary obstruction, direct visualization using a cholangioscope is performed to thoroughly assess the biliary system's anatomy before stent placement (43274). This allows precise stent placement and prevents complications.
Detailed procedural notes should include the type of endoscope used, the method of cannulation, the structures visualized (specific ducts), and any findings that guided subsequent therapeutic interventions.Images of the visualized ducts should be included in the medical record.
** The use of specialized endoscopes like SpyGlass is not a requirement for reporting this code.Direct visualization beyond standard fluoroscopy is the key element.The procedure is performed by inserting a cannula into the papilla, visualizing the biliary and/or pancreatic ducts, and providing a complete report of the findings. The add-on code 43273 can be used with any primary procedure code 43260 through 43278.
- Revenue Code: 0980
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier is not typically applicable to this add-on code.
- Specialties:Gastroenterology
- Place of Service:Office, Ambulatory Surgical Center, Hospital Inpatient/Outpatient