CPT code 43276 – ERCP stent removal and exchange

Key takeaways

CPT Code 43276 covers ERCP stent removal and exchange, distinct from 43274 (placement only) and 43275 (removal only).

The code is billed once per stent exchanged, and sphincterotomy, dilation and guidewire passage are bundled when performed.

Billing 43275 plus 43274 for one exchange triggers National Correct Coding Initiative (NCCI) edits, so 43276 is the correct single code.

Pabau, the practice management platform we build, checks 43276 claims for missing or invalid details and tracks prior authorization codes before submission.

CPT Code 43276: Official descriptor and clinical definition

CPT Code 43276 covers an ERCP that removes an existing biliary or pancreatic duct stent and places a replacement in one session. The AMA descriptor has four parts:

• 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

The phrase “each stent exchanged” is the billing unit. A patient arriving for a routine biliary stent change has one stent exchanged: One unit of 43276. If the endoscopist exchanges a biliary stent and a pancreatic stent in the same session, two units are appropriate, provided each exchange is separately documented.

What CPT Code 43276 includes and excludes

The bundling rules prevent two claim errors on 43276. One is billing services the descriptor already includes. The other is missing services that are legitimately separate.

Bundled into 43276 (do not separately report):

• Removal of the existing stent
• Pre-dilation of the stricture or duct before stent placement
• Post-dilation after the new stent is seated
• Guidewire passage through the stricture or duct
• Sphincterotomy when performed during the same ERCP session
• Contrast injection and imaging integral to stent positioning

Separately reportable (when documented and meeting payer criteria):

• Fluoroscopic guidance (CPT 74328): May be separately reported depending on NCCI edit status and payer policy. The American Society for Gastrointestinal Endoscopy (ASGE) references 74328 as a companion code; verify the current NCCI column 1/2 status before billing.
• Diagnostic ERCP without intervention: A diagnostic ERCP at a separate session is reported with 43260. It cannot be reported with 43276 in the same session for the same duct.
• Multiple stent exchanges: Each additional stent exchanged in the same session warrants an additional unit of 43276, not a separate code.

Sphincterotomy is bundled when performed during the stent exchange. Reporting CPT 43262 (sphincterotomy) separately alongside 43276 for the same session is a frequent NCCI edit trigger. The AMA’s descriptor language “including sphincterotomy when performed” settles this question.

Clinical steps of an ERCP stent exchange

Coders who understand the procedure sequence can match documentation to the code descriptor more precisely, and they catch incomplete operative notes before submitting a claim.

1. Scope insertion and cannulation: The duodenoscope is advanced to the ampulla of Vater. The existing stent is visualized in the biliary or pancreatic orifice.
2. Guidewire placement: A guidewire is passed through or alongside the existing stent into the duct. This step must appear in the operative report; it is part of the bundled descriptor.
3. Stent removal: The old stent is grasped and withdrawn through the scope. The operative report must document that an existing stent was removed, not merely that a new stent was placed. Missing this documentation is a primary denial driver.
4. Dilation (when performed): A balloon or bougie dilates the stricture before or after the new stent is positioned. This is bundled; document it for completeness, not for separate billing.
5. New stent placement: The replacement stent is advanced over the guidewire and deployed across the stricture or anastomosis. Stent type, diameter, and length should be recorded in the report.
6. Sphincterotomy (when performed): If performed, the sphincter is incised before or after stent exchange. Document it in the report; it is bundled into 43276 and must not be separately coded.
7. Fluoroscopic confirmation: Final imaging confirms stent position. If separately billing fluoroscopy (74328), confirm NCCI status and document radiologic supervision and interpretation distinctly.

Documentation requirements for CPT 43276

The operative or procedure note must substantiate every element of the code descriptor. Payers conduct post-payment audits on high-volume ERCP codes, and inadequate documentation triggers recoupment requests even when the clinical procedure was performed correctly.

A compliant 43276 procedure note includes all of the following. Review this list against the superbill documentation your practice generates for each ERCP session.

• Pre-procedure diagnosis: The ICD-10-CM code(s) must reflect the medical indication (see supported diagnoses below). Diagnoses like choledocholithiasis (K80.50-K80.51), biliary stricture (K83.1), or mechanical breakdown of a biliary stent (T85.510A for the initial encounter) are common supporting codes.
• Identification of existing stent: The note must state that a previously placed stent was present and give its type if known. It must also name the location: common bile duct, right/left hepatic duct or pancreatic duct.
• Guidewire passage: Explicitly noted, even as a brief phrase: “guidewire passed through existing stent into common bile duct.”
• Stent removal documented: A sentence confirming the old stent was removed, not merely that a new one was placed. “The 10 Fr plastic biliary stent was grasped and withdrawn” is sufficient.
• Dilation if performed: Balloon size, pressure, and duration noted.
• Sphincterotomy if performed: Extent of incision and any bleeding control measures noted.
• New stent specifications: Type (plastic vs. metal), diameter, and length of the replacement stent.
• Endoscopist attestation: Signature and date from the performing physician, not a resident or fellow unless separately attested and credentialed per facility rules.

CPT 43276 vs. related ERCP codes

The 43260-43278 family covers the full range of ERCP interventions. Choosing the wrong code, or combining incompatible codes in the same session, is the source of most GI endoscopy claim denials.

For the stent codes, two questions settle the choice for each duct. Did the note record removal of an existing stent, and did a new stent go in?

43276 vs. 43274: Stent placement without prior removal

CPT 43274 is the correct code when a new stent is placed without removing an existing one. This happens at a patient’s first stenting, or when the endoscopist places an additional stent alongside a patent existing stent (e.g., bilateral hepatic stenting). CPT 43276 applies when removal and replacement occur together.

Billing 43274 and 43276 for the same duct in the same session violates NCCI bundling edits. If two different ducts are stented in the same session (biliary and pancreatic), one code per duct is appropriate, supported by distinct documentation for each.

43276 vs. 43275: Removal without replacement

CPT 43275 covers stent removal with no new stent placed. This is appropriate when a temporary plastic stent is removed after the underlying condition has resolved (e.g., post-cholecystectomy bile leak that has healed). If a new stent is placed in the same session, 43276 replaces 43275 entirely.

The classic NCCI denial pattern: Coding 43275 plus 43274 for an exchange encounter. The combination is an edit trigger. Use 43276 when both actions occur.

Modifiers for CPT 43276

Modifiers on 43276 communicate procedural context to payers. Incorrect or missing modifiers are a consistent denial source on ERCP claims.

For modifier -22, Medicare requires a concise statement of how the service differed from the usual, plus the operative report, sent with the claim. With both, the MAC prices the claim individually.

Without them, it pays the standard rate, per the Medicare Claims Processing Manual, chapter 12. Commercial payer modifier rules vary, so confirm them in each payer’s LCD or billing policy before appending modifiers routinely.

Medicare and commercial payer reimbursement rates

The CY2026 values below come from the CMS national relative value file (RVU26D, October 2026 release). They are national amounts before your locality adjustment. Check your local rate in the CMS Physician Fee Schedule Look-Up Tool.

The non-facility column is empty because Medicare prices 43276 only in a facility setting. The same file lists 43260 as the endoscopic base code. So the multiple endoscopy payment rule applies when 43276 is billed with other ERCP codes in one session.

Commercial rates for 43276 are usually negotiated as a multiple of Medicare rates and vary widely by contract. Request your fee schedule from each payer every year.

Prior authorization and medical necessity criteria

Many payers require prior authorization for ERCP procedures, including stent exchange. Requirements vary by payer and plan, and the absence of authorization where it is required is a clean, avoidable denial. Confirm authorization requirements at the time of scheduling, not the day before the procedure.

Payers evaluating medical necessity for a 43276 claim typically look for all of the following, consistent with ASGE appropriateness criteria for ERCP. Meeting medical billing compliance standards starts with documenting these elements clearly.

• Appropriate ICD-10-CM diagnosis: Common supporting diagnoses include choledocholithiasis with obstruction (K80.51), biliary stricture (K83.1) and recurrent cholangitis (K83.09). Pancreatitis with ductal involvement (K85.xx) and mechanical breakdown of a biliary stent (T85.510A for the initial encounter) also qualify.
• Prior imaging: MRCP, CT, or ultrasound findings demonstrating the indication (obstruction, stricture, stent dysfunction) should be on file before ERCP is scheduled.
• Failed conservative management or clinical urgency: Notes showing that non-invasive management was considered and was insufficient, or that the clinical presentation required endoscopic intervention.
• Stent interval appropriateness: For routine plastic stent exchanges, the time since the last placement should fall within accepted norms. For plastic biliary stents that is typically 3-6 months. Exchanges before this interval require additional clinical justification (e.g., stent migration, occlusion, cholangitis).
• Credentialed endoscopist: Facilities grant ERCP privileges separately from other endoscopy, following ASGE privileging guidelines. Name the performing endoscopist in the note, and record any referral chain for coverage checks.

Common denial reasons and how to avoid them

43276 claims deny for predictable reasons. Each one traces back to a coding, documentation or scheduling step that the practice controls.

A strong denial management workflow tracks each denial reason by code, monitors patterns by payer, and routes appeals before timely filing limits expire. Knowing the denial codes in medical billing helps your team read remittances accurately.

Before you build a pre-bill review for ERCP codes, check it against the parts of a clean claim.

Is fluoroscopy (CPT 74328) separately billable with 43276?

Fluoroscopy guidance is not bundled into the 43276 descriptor by the AMA’s language, which means it may be separately reportable. Whether a payer accepts it depends on two things: the current NCCI column 1/2 edit status and that payer’s policy.

CPT 74328 covers radiologic supervision and interpretation of a biliary catheter or stent. The ASGE lists it as a companion code to ERCP stent procedures in its annual coding guidance.

Verify the NCCI edit status against the current quarter’s table before billing 74328 alongside 43276. CMS updates NCCI edits every quarter, so a pair that passed last quarter can fail this one.

To separately report 74328, the operative report must contain a distinct radiologic supervision and interpretation note. A sentence stating “fluoroscopy was used to confirm stent position” buried in the endoscopy report is not sufficient. The interpreting physician (often the endoscopist performing dual roles) must document a separate radiologic interpretation with findings, or a radiologist must co-sign.

How claims management software reduces ERCP claim errors

Without software checks, a 43276 error usually surfaces as a denial weeks after the procedure. A missing authorization code, a wrong unit count or an unread remittance code each costs a full resubmission cycle.

Pabau’s claims management software raises each claim from the patient’s invoice and checks it before it leaves the practice. US claims go out as CMS-1500s through Pabau’s Claim.MD integration to thousands of payers. Eligibility checks run before the visit, and the claim stays tied to your medical billing workflow from checkout to payment.

• Claim validation: Pabau scrubs each claim for missing or invalid details before submission. A rejected claim is flagged “Needs action,” with a link to the field that needs fixing.
• Authorization tracking: Each prior authorization is stored as a case that follows the appointment through to the claim. A claim still missing its code is flagged.
• ERA reconciliation: Electronic remittance advice (ERA) flows back into the claims dashboard and is matched to the claims it settles. Denied claims are flagged for rework.

Your billing team sees every 43276 claim in one dashboard, from Pending to Paid. Fewer claims bounce back for avoidable reasons, and the ones that do arrive with the reason attached.

Catch ERCP claim errors before submission

Pabau checks every ERCP claim for missing or invalid details and tracks prior authorization codes. Claims go out through Claim.MD, and ERA payments match back to each claim.

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Conclusion

CPT Code 43276 rewards one habit above the rest. Code from the operative note rather than the schedule, and confirm the note records both the removal and the replacement for each stent.

Hold to that, and the usual denials on this code lose their cause. Split 43275 plus 43274 claims, missed second units and unsupported diagnoses all start from a note that was coded without being read.

The cost is a few minutes of pre-bill review on every ERCP claim. Pabau shortens that review with claim validation, authorization tracking and ERA reconciliation in one system. Book a demo to see how it carries your GI claims from invoice to paid.

Continue your research

Need a reference for medical billing fundamentals? What is revenue cycle management walks through the full billing lifecycle from eligibility to payment posting.

Want to understand how clearinghouses process ERCP claims? Medical claims clearinghouse explains how 837P files reach payers and where edits are applied.

Looking to improve your ERA workflow? Electronic remittance advice covers how to read 835 files and map CARC denial codes back to specific claim lines.

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