CPT® Code 0813T

Official Description

Esophagogastroduodenoscopy, flexible, transoral, with volume adjustment of intragastric bariatric balloon

Common Language Description

The procedure described by CPT® Code 0813T involves an esophagogastroduodenoscopy (EGD), which is a flexible endoscopic examination of the esophagus, stomach, and duodenum. This specific procedure is performed to adjust the volume of a previously placed intragastric bariatric balloon, a device used to assist in weight loss for individuals suffering from obesity. The intragastric balloon is typically made of silicone and is filled with saline, serving as a temporary measure to promote weight loss by occupying space in the stomach, thereby reducing the amount of food that can be consumed at one time. The balloon is usually left in place for a duration ranging from six months to one year. Adjustments to the balloon's volume may be necessary based on the patient's weight loss progress and overall tolerance. For instance, if a patient reaches a weight loss plateau, an increase in the balloon's volume may be warranted to enhance its efficacy. Conversely, a decrease in volume may be required if the patient needs a smaller balloon size to maintain effectiveness or to avoid the need for balloon removal. The procedure is conducted under appropriate sedation, ensuring patient comfort throughout the process. The flexible fiberoptic endoscope is introduced transorally, allowing for a thorough inspection of the esophagus, stomach, and duodenum, while also facilitating the adjustment of the balloon's volume as needed.

1. Indications

The procedure is indicated for patients who have a previously placed intragastric bariatric balloon and require volume adjustments to optimize weight loss outcomes. The specific indications include:

Weight Loss Plateau When a patient has reached a plateau in weight loss, an increase in the balloon's volume may be necessary to stimulate further weight reduction.
Decreased Tolerance If the patient experiences decreased tolerance to the current volume of the balloon, an adjustment may be required to enhance comfort and efficacy.
Need for Volume Reduction In cases where the patient requires a smaller volume to maintain effectiveness or to prevent the need for balloon removal, a decrease in the balloon's volume is indicated.

2. Procedure

The procedure for adjusting the volume of an intragastric bariatric balloon involves several key steps:

Step 1: Preparation and Sedation The patient is prepared for the procedure, which includes obtaining informed consent and administering appropriate sedation to ensure comfort during the endoscopic examination.
Step 2: Insertion of the Endoscope A flexible fiberoptic endoscope is inserted through the patient's mouth and advanced as the patient swallows. This allows for visualization of the esophagus, stomach, and duodenum.
Step 3: Inspection of the Esophagus and Stomach The endoscope is used to inspect the esophagus for any abnormalities. The endoscope is then advanced beyond the gastroesophageal junction into the stomach, where the stomach lining is examined for any issues.
Step 4: Identification of the Balloon Valve The balloon valve of the intragastric balloon is located using the endoscope, which is crucial for the subsequent volume adjustment.
Step 5: Volume Adjustment A filling catheter attached to a syringe is utilized to fill the balloon to the desired volume under direct endoscopic visualization. Once the appropriate volume is achieved, the catheter is detached from the self-sealing valve.
Step 6: Volume Reduction (if necessary) If a decrease in volume is required, a suction catheter may be connected to the valve to remove saline until the desired volume is reached.
Step 7: Withdrawal of the Endoscope After the volume adjustment is complete, the endoscope and any attached catheters are carefully withdrawn from the patient's mouth.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications related to the endoscopy or the volume adjustment. Patients may experience some discomfort or nausea following the procedure, which should be managed appropriately. Instructions regarding diet and activity levels may be provided, and follow-up appointments should be scheduled to assess the effectiveness of the volume adjustment and overall weight loss progress. It is essential to educate the patient on signs of potential complications, such as abdominal pain or difficulty swallowing, that may require prompt medical attention.

Short Descr	EGD VOL ADJMT BARIATRIC BALO
Medium Descr	EGD FLX TRNSORL VOL ADJMT NTRGSTR BARIATRIC BALO
Long Descr	Esophagogastroduodenoscopy, flexible, transoral, with volume adjustment of intragastric bariatric balloon
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	3 - Special payment adjustment 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	43235 Esophagogastroduodenoscopy, flexible, transoral; 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
ASC Payment Indicator	Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Berenson-Eggers TOS (BETOS)	none
MUE	1