Summary & Overview
CPT 43291: Endoscopic Removal of Intragastric Balloon
CPT code 43291 denotes endoscopic removal of an intragastric balloon placed for weight-loss therapy. This code captures a minimally invasive, upper endoscopic procedure in which a flexible endoscope is introduced via the mouth to retrieve a gastric balloon. Nationally, use of intragastric balloons has implications for obesity management, peri-procedural safety, and payer coverage policies.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect an overview of clinical context for the procedure, typical sites of service such as ambulatory surgery centers and hospital endoscopy suites, common billing modifiers, and how this service is reported in claims. The publication highlights benchmarks for utilization and coverage considerations, summarizes relevant coding practice points, and identifies where data is not available in the input. The content is designed for coding professionals, policy analysts, and clinical managers seeking a concise reference on billing and operational aspects of endoscopic intragastric balloon removal.
Billing Code Overview
CPT code 43291 describes removal of an intragastric balloon using a flexible endoscope inserted through the mouth. The procedure is an endoscopic removal of a gastric balloon that was previously placed to assist with weight loss.
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Service type: Endoscopic removal of intragastric balloon
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Typical site of service: Ambulatory surgery center or hospital endoscopy suite
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with a previously placed intragastric balloon for weight loss presents for scheduled removal after the recommended dwell time or earlier due to intolerance (nausea, vomiting, abdominal pain) or deflation concerns. The patient is evaluated in a gastroenterology clinic, reviewed for anesthesia risk, and scheduled for an upper endoscopy under monitored anesthesia care or general anesthesia depending on comorbidities and facility protocols. In the endoscopy suite, a flexible upper endoscope is introduced orally. The endoscopist visualizes the balloon, punctures or opens the valve when necessary, aspirates saline or deflated contents, and removes the collapsed balloon using endoscopic retrieval devices. The procedure includes inspection of the esophagus, stomach, and proximal duodenum for mucosal injury prior to extubation or recovery. Post-procedure, the patient is observed in recovery, given discharge instructions regarding diet progression and signs of complications (bleeding, severe pain, fever), and scheduled for follow-up with the bariatric/gastroenterology team.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no specific modifier applies |
22 |