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The procedure described by CPT® Code 43278 refers to an Endoscopic Retrograde Cholangiopancreatography (ERCP) that includes the ablation of tumors, polyps, or other lesions within the biliary or pancreatic ducts. This advanced endoscopic technique involves the insertion of an endoscope through the esophagus, stomach, and into the duodenum, specifically targeting the ampulla of Vater, where the pancreatic duct and common bile duct converge. The procedure is designed to visualize and treat abnormalities in the biliary and pancreatic systems. During the ERCP, a catheter is introduced through the endoscope to cannulate the ampulla of Vater, allowing for the injection of contrast material. This contrast enhances the visibility of the biliary tract, gallbladder, and pancreas on imaging studies. The sphincter of Oddi is examined, and a guidewire is utilized to facilitate the advancement of the catheter into the biliary tract. The procedure may reveal strictures, filling defects, or other pathological changes that necessitate intervention. If lesions are identified, a balloon catheter can be employed to dilate the affected area, improving access for subsequent ablation. The ablation process involves the use of a laser device, which is carefully maneuvered through the endoscope to destroy the lesions in a controlled manner, ensuring complete removal. This comprehensive approach not only addresses the lesions but also includes pre- and post-dilation as needed, making it a critical procedure for managing biliary and pancreatic ductal pathologies.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 43278 is indicated for the following conditions:
The procedure involves several critical steps to ensure effective diagnosis and treatment:
Post-procedure care following an ERCP with ablation includes monitoring the patient for any immediate complications, such as bleeding or pancreatitis. Patients may be advised to rest and gradually resume normal activities. Follow-up imaging or evaluations may be necessary to ensure that the lesions have been adequately treated and to monitor for any recurrence. Documentation of the procedure and any findings is essential for ongoing patient management and future reference.
| Short Descr | ERCP LESION ABLATE W/DILATE | Medium Descr | ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE | Long Descr | 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 | 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 payment adjustment 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8B - Endoscopy - upper gastrointestinal | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 0397T | Addon Code MPFS Status: Carrier Priced APC N ASC N1 Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure) | 43273 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (List separately in addition to code(s) for primary procedure) |
| 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). | 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. | 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. | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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 | Added | Added |
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