There is a common misconception that CPT® add-on code +43273 for cholangioscopy can only be reported when using a SpyGlass™ scope. After conducting research, I can confirm that this is not accurate, and here’s why.
Focus on the Procedural Note
Endoscopic retrograde cholangiopancreatography (ERCP) involves both diagnostic and therapeutic approaches, with distinct techniques covered under CPT® codes 43260–43278. Additional notes within CPT® guidelines state that these codes can be used in conjunction with 43260–43265 and 43274–43278, as applicable, for each ERCP procedure.
In practice, gastroenterologists typically visualize the bile ducts through deep cannulation during an ERCP procedure. Referring to this procedure as a “SpyGlass” cholangioscopy is incorrect.
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What +43273 Really Requires
The essential requirement for reporting add-on code +43273 is that the provider achieves direct visualization of the bile and/or pancreatic ducts, going beyond the standard fluoroscopic (X-ray) examination. The use of a SpyGlass™ scope is not necessary. In fact, the providers at my practice use an advanced, smaller endoscope that is passed through a larger endoscope for this purpose.
Here is an example of a provider’s documentation for such a procedure:
- The esophagus was successfully intubated under direct vision without examining the pharynx, larynx, and related structures. The upper GI tract appeared grossly normal.
- The major papilla was located at the rim of a diverticulum. A biliary sphincterotomy had been performed and appeared open.
- A 0.025 inch x 270 cm straight Visiglide wire was passed into the biliary tree, followed by the CleverCut distal wire sphincterotome over the guidewire. The bile duct was deeply cannulated, and contrast was injected.
- The bile duct images were interpreted, revealing brisk contrast flow through the ducts. The common bile duct was moderately dilated with the largest diameter measuring 10 mm.
- The biliary sphincterotomy was extended to 8 mm in length using ERBE electrocautery. No post-sphincterotomy bleeding was observed.
- The biliary tree was swept using a 15-20 mm graduated stone retrieval balloon, starting at the right main hepatic duct, to remove sludge.
- The endoscope was withdrawn, and 100 mg of indomethacin was administered via suppository to reduce the risk of post-ERCP pancreatitis (PEP).
- Images were attached to show the major papilla in the duodenum.
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Relevant CPT® Codes:
- 43264: Endoscopic retrograde cholangiopancreatography (ERCP) with removal of calculi/debris from biliary/pancreatic duct(s)
- 43262: ERCP with sphincterotomy/papillotomy
- +43273: Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (Reported separately in addition to the primary procedure code)
Conclusion
The use of the SpyGlass™ scope is not a requirement for reporting CPT® add-on code +43273. Providers can utilize other endoscopic devices to meet the code’s requirement of achieving direct visualization of the bile and/or pancreatic ducts. Understanding this distinction ensures accurate coding for ERCP procedures.