Basics of ERCP CPT Code 74328, 74329 & 74330 

ERCP CPT Code is very common while coding radiology procedures. ERCP stands for endoscopic retrograde cholangiopancreatography (ERCP). The exam is performed using an endoscope and taking x rays simultaneously. These codes are coded both in surgical and diagnostic coding.

ERCP CPT Code is easy to learn if we know the anatomy and how the procedure is performed. The endoscope is inserted through the mouth into the oropharynx, esophagus, stomach, and into the small intestine until it reaches the point where the ducts from the pancreas and gallbladder drain into the duodenum.

The pancreatic ducts (pancreas) and bile ducts (gallbladder) are studied in ERCP exam. Once the cannula reaches to the examine area, dye is injected and X rays are taken.

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Description of  ERCP cpt code 74328, 74329 & 74330

An endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure of the pancreatic ducts, hepatic ducts, common bile ducts, duodenal papilla, and/or gallbladder (hepatobiliary system) and is performed primarily to diagnose and treat conditions of the bile ducts, including gallstones,
inflammatory strictures (scars), leaks (due to trauma or surgery), disease of the liver, and cancer. ERCP combines the use of x-rays and endoscope.

Through the endoscope, the physician can visualize the inside of the stomach and duodenum, and injects dye into the ducts of the biliary tree and pancreas to be viewed on x-ray. The scope is advanced through the esophagus, into the stomach, to the duodenal  papilla (papilla of Vater), and contrast is then injected to visualize the bile ducts and biliary tract, including the gallbladder. Assignment of these codes is based on purpose of the procedure as diagnostic or therapeutic. The codes do not include the radiological supervision and interpretation, so when performed.

In this exam, the physician performs an endoscopic retrograde cholangiopancreatography (ERCP) for diagnostic or therapeutic reasons. The physician passes the endoscope through the patient’s oropharynx, esophagus, stomach, and into the small intestine. A smaller subscope may be inserted through the sphincter of Oddi into the system of ducts that drain the pancreas (CPT code 74329) or into the biliary ductal system that drains the gallbladder ( CPT code 74328), or both ( CPT code 74330). These codes report only the radiological supervision and interpretation required in performing this procedure to the respective extent of catheterization.

The exam is done to find any symptoms or disorders related to liver, bile ducts and pancreas. It helps in finding any persistent pain in abdominal region. Gallstones can be easily diagnosed with ERCP exam. Inflammation like pancreatitis and infection like cholangitis of abdomen area can also be treated nicely with this exam. ERCP exam hence helps in solving many harmful disorders of abdominal region. Let’s check out the ERCP CPT code used in medical coding:

74328– Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation

74329– Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation

74330– Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation

These are the radiological supervision and interpretation (S&I) codes. The above codes are used with surgical codes (43260-43278, if only we have code S&I code only,  we have to code above codes with 26 modifier for professional component.

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ERCP CPT codes in Surgery

In Surgery, ERCP CPT codes are used  to report stenting procedures. For example, CPT code 43274 and 43275 is used for ERCP procedure for insertion of tube, stent or removal of Foreign body. Below are their details code description.

CPT code 43267, 43268 & 43269 are deleted from 2014. Use  CPT code 43274, 43275, 43276 in place of these codes. 

43274  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 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s)

43276 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

For stent placement in both the pancreatic duct and the common bile duct during the same operative session, placement of separate stents in both the right and left hepatic ducts, or placement of two side-by-side stents in the same duct, 43274 may be reported for each additional stent placed, using modifier 59 with the subsequent procedure[s].

Do not report 43275 in conjunction with 43260, 43274, 43276

CPT code 43275 should be reported only once for removal of one or more stents or foreign bodies from biliary/pancreatic duct[s] during the same session

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Details about ERCP CPT Code

The ERCP CPT codes are less in number. The codes are given on the basis of the anatomic area. The CPT codes are only three and the codes are easy to code. There are separate codes for ERCP procedure done on Bile duct (74328) and pancreatic duct (74329). Also, when the ERCP exam is done to evaluate both bile and pancreatic duct, we have a combined code 74330.Most common indication for ERCP procedures are

Abdominal Pain

Chronic Pancreatitis

Jaundice

Gallstones

Biliary Stricture

Hope this article helps you to learn about ERCP CPT Code and its basics. Please share if you like the article.