Endoscopic Retrograde Cholangiopancreatography (ERCP)

CPT coding guidelines ERCP/ CPT coding guidelines 2023, CPT coding guidelines digestive system / CPC exam preparation 2023  

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Definition of ERCP:

Examination of the hepatobiliary system (pancreatic ducts, hepatic ducts, common bile ducts, duodenal papilla [ampulla of Vater] and gallbladder [if present]) is performed through a side-viewing flexible fiberoptic endoscope.

5 Important Coding guidelines of ERCP:

1. 1. Report the appropriate code(s) for each service performed.
   2. Therapeutic ERCP (43261, 43262, 43263, 43264, 43265, 43274, 43275, 43276, 43277, 43278) includes diagnostic ERCP (43260). ERCP includes guide wire passage when performed.
   3. An ERCP is considered complete if one or more of the ductal system(s), (pancreatic/biliary) is visualized
   4. To report ERCP attempted but with unsuccessful cannulation of any ductal system, see 43235- 43259, 43266, 43270
   5. percutaneous biliary catheter procedures, see 47490-47544

NCCI edit Guidelines

1. 1. ERCP with stent placement includes any balloon dilation performed in that duct.
   2. ERCP with more than one stent placement (eg, different ducts or side by side in the same duct) performed during the same day/session may be reported with 43274 more than once with modifier 59 appended to the subsequent procedure(s).
   3. For ERCP with more than one stent exchanged during the same day/session, 43276 may be reported for the initial stent exchange, and 43276 with modifier 59 for each additional stent exchange.
   4. ERCP with balloon dilation of more than one duct during the same day/session may be reported with modifier 59 appended to the subsequent procedure(s)

2. 1. Sphincteroplasty, which is balloon dilation of the ampulla (sphincter of Oddi), is reported with 43277, and includes sphincterotomy (43262) when performed.
   2. To report optical endomicroscopy of the biliary tract and pancreas, use 0397T. Do not report optical endomicroscopy more than once per session. (For bilateral balloon dilation [both right and left hepatic ducts], 43277 may be reported twice with modifier 59 appended to the second procedure) (For transendoscopic balloon dilation of multiple strictures during the same session, use 43277 with modifier 59 for each additional stricture dilated)
   3. Do not report 43277 in conjunction with 43274, 43276 for dilation and stent placement/replacement [exchange] in the same duct)
   4. Endoscopic cannulation of papilla (43273) may be coded once per procedure.