43264

Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde removal of calculus/calculi from biliary and/or pancreatic ducts

CPT code 43264 describes an Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure specifically performed for the endoscopic retrograde removal of calculus or calculi (stones) from the biliary ducts (e.g., common bile duct, hepatic ducts) and/or pancreatic ducts. This therapeutic procedure combines endoscopic visualization with fluoroscopic imaging to diagnose and treat conditions affecting the bile and pancreatic ducts. The procedure involves inserting an endoscope through the mouth, esophagus, stomach, and duodenum to reach the ampulla of Vater. Contrast material is injected into the ducts, and X-ray images are taken. Following visualization and identification of stones, various endoscopic techniques such as sphincterotomy, balloon dilation, and stone extraction with specialized devices (e.g., retrieval balloons, baskets) are employed to remove the calculi. This procedure is typically performed in an outpatient or inpatient setting under moderate sedation or general anesthesia.

Clinical Indications

  • Choledocholithiasis (common bile duct stones) causing obstruction, cholangitis, or pancreatitis
  • Pancreatic duct stones causing recurrent pancreatitis or ductal obstruction
  • Cholangitis due to biliary calculi
  • Obstructive jaundice due to choledocholithiasis
  • Gallstone pancreatitis with persistent common bile duct obstruction

Procedure Steps

  1. Patient preparation, including NPO status and administration of appropriate sedation or general anesthesia.
  2. Insertion of a side-viewing duodenoscope through the mouth, esophagus, stomach, and into the duodenum.
  3. Localization and cannulation of the ampulla of Vater using a catheter.
  4. Injection of contrast material into the biliary and/or pancreatic ducts under fluoroscopic guidance to visualize stones and ductal anatomy.
  5. Performance of endoscopic sphincterotomy or balloon dilation of the sphincter of Oddi if necessary to facilitate access and stone removal.
  6. Advancement of specialized devices (e.g., retrieval balloons, baskets) past the calculus/calculi.
  7. Mechanical fragmentation or extraction of calculus/calculi using a basket or balloon.
  8. Repeat imaging to confirm stone removal and ductal patency.
  9. Removal of the endoscope.

Coding Guidelines

  • CPT code 43264 includes the diagnostic ERCP component when performed for stone removal. It should not be reported separately with diagnostic ERCP codes (e.g., 43260, 43261).
  • If an ERCP with stone removal is performed and a stent is also placed during the same session for the same ductal system, only the code for the stent placement (e.g., 43269, 43270) should be reported, as stone removal is considered an integral part of preparing for or facilitating stent placement in many cases.
  • Mechanical lithotripsy (43273) may be reported in addition to 43264 if performed to fragment stones that cannot be removed intact.
  • Intraductal ultrasound (IDUS) (43275) or cholangioscopy (43276) can be reported separately if performed and documented for medical necessity.
  • This code has a 0-day global period.
  • Documentation must clearly describe the presence of calculi, the location (biliary or pancreatic duct), and the method of endoscopic removal.

Associated ICD-10 Codes