Coding Ahead
CasePilot
Medical Coding Assistant
Case2Code
Search and Code Lookup Tool
CareerCenter
Medical Coding Job Board
Log in Register free account

Need help choosing the right code?

Ask CasePilot about procedures, modifiers, bundling, and coding guidance.

Try CasePilot
CPT®
43267

CPT® Code 43267
Deleted

Code deleted, see 43274

Official Description

Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde insertion of nasobiliary or nasopancreatic drainage tube

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts and pancreatic duct. During this procedure, an endoscope, which is a flexible tube equipped with a camera and light, is carefully inserted through the patient's mouth, advancing through the esophagus and stomach, and into the duodenum. The goal is to reach the Ampulla of Vater, the anatomical site where the pancreatic duct and common bile duct converge. Once the endoscope is positioned correctly, a smaller catheter is introduced through the endoscope to cannulate the Ampulla of Vater. This allows for the injection of contrast dye into the ducts, enabling visualization of the biliary tract, gallbladder, and pancreas via x-ray imaging. The procedure is particularly important for identifying blockages, stones, or other abnormalities within these ducts. Following the visualization, a nasobiliary or nasopancreatic drainage tube is inserted into the appropriate duct to facilitate the drainage of secretions. This drainage tube extends from the duct through the gastrointestinal tract and exits through the nose, serving to prevent the accumulation of bile or pancreatic secretions in the abdominal cavity, which could lead to complications such as infection or inflammation.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

Endoscopic retrograde cholangiopancreatography (ERCP) with the insertion of a nasobiliary or nasopancreatic drainage tube is indicated for various clinical scenarios. The following conditions may warrant the performance of this procedure:

  • Obstructive jaundice - This condition occurs when there is a blockage in the bile duct, leading to the accumulation of bile and subsequent jaundice.
  • Cholestasis - A reduction or stoppage of bile flow can necessitate ERCP to identify and relieve the underlying cause.
  • Pancreatitis - In cases of acute or chronic pancreatitis, ERCP may be performed to evaluate and manage complications such as ductal obstruction.
  • Biliary stones - The presence of gallstones in the bile duct can lead to significant complications, and ERCP is utilized to remove these stones.
  • Strictures - Narrowing of the bile or pancreatic ducts can be diagnosed and treated during ERCP.

2. Procedure

The procedure of endoscopic retrograde cholangiopancreatography (ERCP) with the insertion of a nasobiliary or nasopancreatic drainage tube involves several critical steps:

  • Step 1: Patient Preparation - The patient is positioned comfortably, and sedation is administered to ensure relaxation and minimize discomfort during the procedure. Monitoring equipment is set up to track vital signs throughout the process.
  • Step 2: Endoscope Insertion - The endoscope is carefully inserted through the patient's mouth and advanced through the esophagus and stomach into the duodenum. The endoscopist visualizes the gastrointestinal tract using the camera on the endoscope.
  • Step 3: Cannulation of the Ampulla of Vater - Once the endoscope reaches the duodenum, the endoscopist locates the Ampulla of Vater. A smaller catheter is then passed through the endoscope to cannulate the Ampulla, allowing access to the pancreatic and bile ducts.
  • Step 4: Contrast Injection - Contrast dye is injected through the catheter into the bile and pancreatic ducts. This step is crucial for visualizing the anatomy and any potential obstructions or abnormalities via fluoroscopy.
  • Step 5: Imaging - X-ray images are taken immediately after the contrast is injected, providing real-time visualization of the biliary tract, gallbladder, and pancreas.
  • Step 6: Tube Placement - If indicated, a nasobiliary or nasopancreatic drainage tube is advanced over a guidewire into the appropriate duct. This tube is designed to facilitate the drainage of secretions from the bile or pancreatic duct.
  • Step 7: Tube Exit - The drainage tube is positioned to extend from the biliary or pancreatic duct through the duodenum, stomach, and esophagus, ultimately exiting through the nose.

3. Post-Procedure

After the completion of the ERCP procedure, the patient is monitored in a recovery area to ensure stability and to manage any potential complications. It is common for patients to experience some throat discomfort due to the endoscope insertion, which typically resolves quickly. The drainage tube may remain in place for a specified duration, depending on the clinical situation, and the healthcare team will provide instructions for care and monitoring of the tube. Patients are advised to follow up with their healthcare provider to assess the effectiveness of the drainage and to plan any further treatment if necessary. Additionally, any signs of complications, such as fever, abdominal pain, or unusual drainage from the tube, should be reported immediately to a healthcare professional.
Short Descr ENDO CHOLANGIOPANCREATOGRAPH
Medium Descr ERCP W/INSJ NASOBILIARY/NASOPNCRTC DRAINAGE TUBE
Long Descr Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde insertion of nasobiliary or nasopancreatic drainage tube
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 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 Procedure or Service, Multiple Reduction Applies
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE Not applicable/unspecified.
CCS Clinical Classification 82 - Endoscopic retrograde cannulation of pancreas (ERCP)
Date
Action
Notes
2014-01-01 Deleted Code deleted, see 43274
2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
Code
Description
Code
Description
Code
Description
CasePilot

Get instant expert-level medical coding assistance.

Ask about:
CPT Codes Guidelines Modifiers Crosswalks NCCI Edits Compliance Medicare Coverage
Example: "What is CPT code 99213?" or "Guidelines for E/M services"