2025 CPT code 43274
(Active) Effective Date: N/A Revision Date: N/A Surgery - Endoscopic Retrograde Cholangiopancreatography (ERCP) Procedures Surgery Feed
Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic stent placement in a biliary or pancreatic duct; includes pre- and post-dilation, guidewire passage, and sphincterotomy when performed; each stent.
Modifiers may be necessary to indicate multiple procedures (-51, -59), unusual circumstances (-22), or other relevant clinical situations. Consult the CPT® guidelines and payer guidelines for appropriate modifier usage.
Medical necessity for 43274 is established when there is a documented clinical indication for stent placement in the biliary or pancreatic duct, such as obstruction from stones, strictures, or tumors. Documentation should clearly link the clinical symptoms, diagnostic findings, and the need for stent placement to improve patient outcomes.
The gastroenterologist or surgeon inserts an endoscope into the patient's digestive tract, navigates to the ampulla of Vater, cannulates the biliary and/or pancreatic duct(s), and places a stent(s). They may also perform pre- and post-dilation, guidewire passage, and sphincterotomy as needed. Post-procedural monitoring is also part of the clinical responsibility.
In simple words: This code describes a procedure where a doctor uses a thin, flexible tube with a camera (endoscope) to place a small, mesh tube (stent) inside a bile duct or pancreatic duct to keep it open.The procedure may also involve widening the duct and/or making a small cut to help place the stent. This code is used for each stent placed.
Endoscopic retrograde cholangiopancreatography (ERCP) involves the placement of an endoscopic stent into a biliary or pancreatic duct.The procedure includes pre- and post-dilation of the duct as needed, passage of a guidewire, and sphincterotomy if performed.This code is reported for each individual stent placed.Note that this code does not include separate reporting of diagnostic ERCP (43260), which is considered inherent to the procedure.Do not report 43274 with codes 43262, 43275, 43276, 43277 for stent placement or replacement (exchange) in the same duct. For multiple stent placements in the same session (e.g., different ducts or side-by-side stents), 43274 may be reported multiple times with modifier -59 appended to subsequent procedures.If naso-biliary or naso-pancreatic drainage tube placement is performed, use 43274.
Example 1: A 65-year-old male presents with jaundice and elevated bilirubin levels.ERCP reveals a common bile duct stone.A stent is placed to relieve obstruction.Code 43274 is reported., A 50-year-old female with a history of pancreatitis undergoes ERCP, revealing a stricture in the pancreatic duct.A stent is placed to maintain patency.Code 43274 is reported., A 70-year-old male post-cholecystectomy presents with recurrent biliary pain.ERCP reveals a stricture in the common bile duct.Stent placement is performed; code 43274 is reported.
* Pre-procedure diagnosis and indication for ERCP.* Detailed procedural notes including cannulation of which duct(s) and stent placement details (type of stent, location, size).* Imaging studies (fluoroscopy images) to document the procedure and stent placement.* Documentation of pre- and post-dilation, guidewire passage, and sphincterotomy if performed.* Post-procedure clinical notes, including any complications.* Patient's medical history relevant to the procedure.
** Always refer to the most current CPT® coding manual and payer-specific guidelines for the most accurate and up-to-date coding practices.This information is for guidance only and should not be considered a substitute for professional medical coding advice.
- Revenue Code: P8B (Endoscopy - Upper Gastrointestinal)
- RVU: Refer to the AMA's CPT codebook or your payer's fee schedule for the most up-to-date RVU values.Note that RVUs are subject to change.
- Global Days: The global period for this procedure is dependent on the specific circumstances and payer's guidelines.Consult your payer's specific rules.
- Payment Status: Active
- Modifier TC rule: Not applicable; this code represents the entire procedure.
- Fee Schedule: Fee schedules vary by payer and geographical location.Historical fee data is not available here; please refer to your payer's historical fee schedules.
- Specialties:Gastroenterology, Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center