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The procedure described by CPT® Code 43273 involves the endoscopic cannulation of the papilla, which is a critical step in the evaluation of the pancreatic and common bile ducts. This procedure is performed with direct visualization, allowing healthcare professionals to assess these ducts for any abnormalities or conditions that may not be visible through standard radiographic imaging techniques. The endoscopic cannulation is typically conducted during an endoscopic retrograde cholangiopancreatography (ERCP), which is a more comprehensive procedure aimed at diagnosing and treating conditions related to the biliary and pancreatic systems. During the procedure, a duodenoscope is utilized, which is a specialized endoscope designed to navigate through the gastrointestinal tract, specifically reaching the duodenum where the papilla of Vater is located. The physician inserts a catheter through the duodenoscope to inject contrast material into the ducts, enabling fluoroscopic imaging to visualize the anatomy and any potential obstructions or pathologies. Following this, a guidewire is advanced through the scope to facilitate further examination of the biliary tree. The procedure is essential for identifying diseases such as strictures, stones, or tumors within the ducts, thereby guiding subsequent therapeutic interventions.
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The endoscopic cannulation of the papilla with direct visualization of the pancreatic and common bile ducts is indicated for various clinical scenarios. These indications include:
The procedure involves several critical steps to ensure accurate cannulation and visualization of the ducts. These steps include:
Post-procedure care following the endoscopic cannulation of the papilla typically involves monitoring the patient for any immediate complications, such as bleeding or pancreatitis. Patients may be observed for a short period in a recovery area to ensure stability before discharge. It is essential to provide instructions regarding dietary modifications and signs of potential complications that should prompt immediate medical attention. Follow-up appointments may be scheduled to discuss the results of the procedure and any further management required based on the findings.
| Short Descr | ENDOSCOPIC PANCREATOSCOPY | Medium Descr | ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC | Long Descr | Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (List separately in addition to code(s) for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple 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) | 0 - 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. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8I - Endoscopy - other | MUE | 1 | CCS Clinical Classification | 82 - Endoscopic retrograde cannulation of pancreas (ERCP) |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 43260 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | 43261 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple | 43262 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy | 43263 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi | 43264 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s) | 43265 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Endoscopic retrograde cholangiopancreatography (ERCP); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy) | 43274 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent | 43275 | Resequenced Code MPFS Status: Active Code APC J1 ASC G2 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) | 43276 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 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 | 43277 | Resequenced Code MPFS Status: Active Code APC J1 ASC G2 Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct | 43278 | Resequenced Code MPFS Status: Active Code APC J1 ASC G2 Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2014-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Medium description changed. |
| 2009-01-01 | Added | - |
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