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Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized medical procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions affecting the bile and pancreatic ducts. This procedure is particularly useful in cases where there is a blockage or narrowing (stenosis) in these ducts. During ERCP, a flexible tube known as an endoscope is inserted through the patient's mouth, passing through the esophagus and stomach, and into the duodenum, which is the first part of the small intestine. The procedure specifically targets the Ampulla of Vater, the anatomical site where the pancreatic duct and the common bile duct converge. Once the endoscope reaches this location, a smaller catheter is introduced through the endoscope to access the ducts. The Ampulla of Vater is cannulated, allowing for the injection of contrast dye into the bile and pancreatic ducts. This contrast dye is crucial as it enables visualization of the ducts on x-ray images, helping to identify any obstructions, stones, or other abnormalities. If a stricture is detected, the catheter can be advanced over a guidewire into the affected duct. Additional contrast dye may be injected to enhance the imaging of the stricture. To alleviate the blockage and facilitate the drainage of bile or pancreatic secretions, a plastic tube or stent is then inserted into the narrowed area. This intervention not only aids in diagnosis but also provides therapeutic relief for the patient.
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The procedure of endoscopic retrograde cholangiopancreatography (ERCP) with the insertion of a tube or stent is indicated for various conditions affecting the bile and pancreatic ducts. These indications include:
The procedure of ERCP with endoscopic retrograde insertion of a tube or stent involves several critical steps to ensure successful diagnosis and treatment. The process begins with the patient being positioned comfortably, often in a sedated state to minimize discomfort. The endoscope, a flexible tube equipped with a camera and light, is carefully inserted through the mouth and advanced through the esophagus and stomach into the duodenum. This step is crucial as it allows the physician to visualize the Ampulla of Vater, the junction where the pancreatic duct and common bile duct meet.
After the completion of the ERCP procedure, patients are typically monitored in a recovery area until the effects of sedation wear off. It is common for patients to experience some discomfort, such as a sore throat or abdominal cramping, which usually resolves within a short period. Patients may be advised to refrain from eating or drinking for a few hours post-procedure until they are fully alert and able to swallow safely. Follow-up care may include instructions on monitoring for any signs of complications, such as fever, increased abdominal pain, or changes in bowel habits. Depending on the findings during the procedure, further treatment or follow-up imaging may be necessary to ensure the effectiveness of the intervention and to monitor the condition of the bile or pancreatic ducts.
| Short Descr | ENDO CHOLANGIOPANCREATOGRAPH | Medium Descr | ERCP W/INSJ TUBE/STENT BILE/PANCREATIC DUCT | Long Descr | Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special rules for multiple endoscopic procedures apply... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8B - Endoscopy - upper gastrointestinal | MUE | Not applicable/unspecified. | CCS Clinical Classification | 82 - Endoscopic retrograde cannulation of pancreas (ERCP) |
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| 2014-01-01 | Deleted | Code deleted, see 43274 |
| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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