Question

Sphincteroplasty, which is a balloon dilation of the ampulla (sphincter of Oddi), is reported with which CPT code, and includes sphincterotomy (43262) when performed?

a) 43261
b) 43262
c) 43263
d) 43264

Answer 1

The correct CPT code for a sphincteroplasty that includes a sphincterotomy when performed is 43262.

Step-by-step explanation:

The CPT code used to report a sphincteroplasty, which is a balloon dilation of the ampulla, and includes a sphincterotomy when performed, is 43262. This code specifically accounts for endoscopic retrograde cholangiopancreatography (ERCP) with balloon dilation of the sphincter of Oddi, and sphincterotomy if it is performed concurrently. Code 43261 is used for ERCP with biopsy, code 43263 for ERCP with removal of calculus, and code 43264 for ERCP with stent placement, none of which precisely describe the sphincteroplasty procedure.