2025 CPT code 43291
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Removal of an intragastric bariatric balloon via flexible endoscope.
Modifiers 52 (reduced services) and 53 (discontinued procedure) may apply in certain circumstances, such as inability to complete the procedure as planned.Refer to the current CPT guidelines for details.
Removal of an intragastric bariatric balloon is medically necessary when the balloon has completed its intended purpose or when complications arise requiring its removal. Documentation should clearly support the medical necessity of the procedure.
The physician's responsibility includes patient preparation and anesthesia (if applicable), insertion and navigation of the endoscope, removal of balloon contents and the balloon itself, and post-procedure monitoring.The physician should document the procedure thoroughly and appropriately.
In simple words: The doctor uses a thin, flexible tube with a camera on the end (endoscope) to remove a weight-loss balloon from the patient's stomach. The balloon was previously inserted to help with weight loss.
Esophagogastroduodenoscopy (EGD), flexible, transoral; with removal of intragastric bariatric balloon(s).This procedure involves the insertion of a flexible endoscope through the patient's mouth to visualize the esophagus, stomach, and duodenum. The scope is used to remove the contents (e.g., saline) and then the deflated intragastric bariatric balloon itself.
Example 1: A patient had an intragastric balloon placed six months prior for weight loss.The balloon is now ready for removal. The physician performs an EGD to remove the balloon and its contents., A patient experiences complications with an intragastric balloon, such as discomfort or migration.The physician performs an EGD to remove the device., A patient completes their weight loss goals with an intragastric balloon and desires removal.The physician schedules an EGD for balloon removal.
* Pre-procedure patient assessment and evaluation.* Informed consent documentation.* Detailed operative report describing the procedure, including visualization of the esophagus, stomach, and duodenum.Specifics about balloon removal, type of balloon, and contents removed should also be documented.* Any complications or adverse events should be documented completely.* Post-procedure patient assessment and instructions.
** This code is specifically for the removal of an intragastric bariatric balloon.Placement of the balloon is coded separately (43290).Accurate documentation of the type and size of the balloon is essential for proper coding and billing.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- RVU: RVUs will vary based on geographic location and other factors. Consult your local Medicare Administrative Contractor (MAC) for specific payment rates.
- Global Days: The global period for this procedure is typically 0 days, meaning there is no post-operative follow-up period included in the code.Any post-operative care would be separately billable.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier is not applicable to 43291 as the procedure is primarily a professional service.
- Fee Schedule: Fee schedules vary by geographic location and payer.Historical data is not readily available in this context but can be retrieved via specific payer fee schedules.
- Specialties:Gastroenterology
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient Department