2025 CPT code 43276
Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Endoscopic retrograde cholangiopancreatography (ERCP) with removal and exchange of stent(s) in the biliary or pancreatic duct.
Modifiers such as 22 (Increased Procedural Services), 51 (Multiple Procedures), 59 (Distinct Procedural Service), 76 (Repeat Procedure by Same Physician), and 77 (Repeat Procedure by Another Physician) may be applicable depending on the specific circumstances.
Medical necessity for 43276 must be established by documenting the underlying condition requiring the stent exchange (e.g., blockage, stricture, migration) and its impact on the patient's health. The documentation should support that the stent exchange is necessary and appropriate for the patient's condition.
The physician inserts an endoscope through the patient's mouth, down the esophagus, and into the small intestine to visualize the bile and pancreatic ducts. A guidewire may be used. Then, the existing stent in the duct is removed, and a new one is inserted. Dilation (widening) of the duct may be performed before or after stent exchange. If necessary, a sphincterotomy (small cut in the muscle that controls bile flow) might be performed.
In simple words: This procedure involves using a thin, flexible tube with a camera to view the inside of the digestive system and replace a small tube-like device (stent) within the bile or pancreatic ducts.This stent helps fluids drain properly. The procedure may also involve widening the duct.
Endoscopic retrograde cholangiopancreatography (ERCP); with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged. (43276 includes removal and replacement [exchange] of one stent. For replacement [exchange] of additional stent[s] during the same session, report 43276 with modifier 59 for each additional replacement [exchange]) (Do not report 43276 in conjunction with 43260, 43275) (Do not report 43276 in conjunction with 43262, 43274 for stent placement or exchange in the same duct)
Example 1: A patient with a blocked bile duct due to a tumor has a stent placed to allow bile drainage. After some time, the stent needs to be exchanged due to blockage or migration. The physician performs ERCP with stent exchange (43276)., A patient with chronic pancreatitis experiences recurrent blockage of the pancreatic duct. A stent was previously placed, and during a follow-up ERCP, the physician removes the old stent and replaces it with a new one (43276) to maintain duct patency., A patient with a biliary stricture (narrowing) has a stent placed. During a follow-up ERCP, the physician exchanges the stent (43276) and performs dilation to address the stricture and improve drainage.
Documentation should include the following: Indication for the procedure (e.g., blocked bile duct, stricture); Details of the ERCP procedure, including visualization of the ducts, stent removal, stent placement, dilation performed (if any), and sphincterotomy (if performed); Size and type of stent exchanged;Complications (if any);Pre- and post-procedure diagnoses.
- Revenue Code: P8B
- Specialties:Gastroenterology, General Surgery
- Place of Service:Ambulatory Surgical Center, Outpatient Hospital, Inpatient Hospital