Basics of CPT code 43290 and 43291
Currently, several CPT codes describe procedures to induce weight loss, such as codes 43644 and 43645 (laparoscopic gastric bypass), codes 43770-43775 (laparoscopic gastric banding and laparoscopic sleeve gastrectomy), code 43845 (open biliopancreatic diversion), and code 43846 (open gastric bypass). These are invasive procedures that permanently alter the gastrointestinal (GI) tract. From 2023, to report EGD performed to assist with weight loss, new codes have been established for the deployment (43290) and removal (43291) of an intragastric balloon via a flexible transoral endoscope.
Esophagogastroduodenoscopy is a procedure performed to examine the esophagus, stomach, duodenum, and sometimes the jejunum for signs of bleeding, tumors, erosion, ulcers, or other abnormalities. The EGD is often performed in conjunction with another procedure. During this procedure, a special suturing system is inserted through the scope, the physician then places a series of stitches in the esophagogastric junction, essentially pleating the sphincter to prevent the backflow of stomach acid into the esophagus. The medical necessity of the procedure would be demonstrated with a diagnosis code, such as K21.9.
Description of CPT code 43290 and 43291
In a minimally invasive endoscopic surgery, the physician inserts an intragastric bariatric balloon into an obese patient (CPT code 43290). The deflated gastric balloon is inserted through the esophagus and into the stomach. Once the balloon is in an appropriate position, the central wire from the balloon is removed. A syringe is used to fill the balloon with a sterile saline solution. At the physician’s discretion, the balloon may be filled with 50 mL at a time and up to 500 mL, dependent on the balloon type. The catheter is removed with the balloon staying within the stomach cavity. Endoscope may be utilized to ensure the balloon is not too snug within the stomach or wedged with the potential to cause an outlet obstruction in the stomach. At the conclusion of the procedure, the endoscope is withdrawn. Light sedation, local, or general anesthesia may be utilized.
In CPT code 43291, the physician removes one or more intragastric bariatric balloons. An endoscopic camera is introduced into the stomach through the esophagus. The balloon is punctured, aspirated, or connected to suction to remove the saline or gas. The balloon is deflated, grasped with forceps, and removed through the mouth. The physician may utilize a lubricating material such as mineral oil to ease the removal of the balloon through the esophagus.
43290 Esophagogastroduodenoscopy, flexible, transoral; with deployment of intragastric bariatric balloon
43291 ; with removal of intragastric bariatric balloon(s)
EGD is reported when an endoscope traverses the pyloric channel and enters the small intestine. Prior to 2023, the CPT code set did not include specific codes that described these procedures. The procedures are performed to assist in the treatment of conditions such as weight loss, generally for patients who have comorbid conditions complicating their obesity diagnosis (eg, hypertension, type II diabetes, fatty liver disease). Note that examination of the proximal duodenum or jejunum is required in the procedure described by the EGD codes.
To report esophagogastroscopy where the duodenum is deliberately not examined (eg, judged to be clinically not pertinent), or the clinical situation precludes such examination (eg, significant gastric retention precludes safe examination of the duodenum), append modifier 52, Reduced Services, if repeat examination is not planned, or modifier 53, Discontinued Procedure, if repeat examination is planned.
Clinical example of Procedure code 43290
A 45-year-old female with a body mass index (BMI) of 33, who has not responded to dietary and pharmacologic interventions for weight loss, undergoes endoscopically guided insertion of a gastric balloon.
Clinical example of Procedure code 43291
A 45-year-old female who is 6 months post-placement of an intragastric balloon presents for removal of the balloon.