In this article, we explain the Endoscopic Sleeve Gastroplasty CPT Code, coding guidelines, Documentation requirements, practical example and how coders can apply best practical in real cases.
What is endoscopic sleeve gastroplasty?
ESG is a minimally invasive alternative to sleeve gastrectomy procedure and other bariatric endoscopic procedure. Sleeve Gastroplasty is also known as ESG stomach tightening
In this procedure an endoscope is inserted through the mouth, down the esophagus, and into the stomach without making any cuts into the abdomen. Stitches are used to close off a portion of the stomach and reduce the stomach to a tubelike sleeve, about 30% of its original size.
ESG is commonly used for patients with obesity and overweight.
CPT includes
- CPT 43235-EGD
- CPT 43197-Transnasal Diagnostic esophagoscopy
- CPT 43200-Esophagoscopy Flexible
- CPT 43191-Esophagoscopy Rigid
Endoscopic Sleeve Gastroplasty CPT Code Description:
ESG CPT Code 43889-Gastric restrictive procedure, transoral, endoscopic sleeve gastroplasty (ESG), including argon plasma coagulation, when performed.
Required Documentation to code CPT code 43889
- use of endoscope via oral approach
- Internal gastric suturing to reduce stomach size
- no surgical gastrectomy performed
Medical necessity for Endoscopic sleeve gastroplasty is Obesity and overweight and BMI documentations
common ICD codes for ESG procedures
- E66.01-Morbid obesity due to excess calories
- E66.9-Obesity, unspecified
- E66.3-Overweight
- Z68.30-Z68.45- BMI codes must be reported when documented as per ICD 10 guidelines.
ESG Procedure Documentation Example
Procedure performed: Sleeve gastroplasty for gastric restriction
Pre/postoperative diagnosis: Morbid Obesity with BMI 40, Type 2 diabetes, hypertension, OSA
Indications: 38-year-old female with a body mass index of 40 with obesity-related comorbidities. Has failed to achieve weight loss with conservative measures
Procedure description: General anesthesia was administered. The patient was placed in the left lateral decubitus position on the endoscopy table. Standard time-out was performed. A therapeutic gastroscope equipped with a full-thickness endoscopic suturing device was introduced orally and advanced under direct visualization through the esophagus into the stomach. Exams of the esophagus, stomach, and duodenum were all normal. The stomach was carefully inspected and insufflated to assess size and orientation.
Working predominantly along the greater curvature, a series of full-thickness sutures were placed to reduce the gastric lumen and create a tubular, sleeve-like configuration, sparing the lesser curvature. After each suture line was completed, the suture line was cinched and secured, resulting in progressive plication and tabularization of the stomach along the lesser curvature axis
Continuous visualization confirmed full-thickness engagement of the gastric wall. Care was taken to avoid the lesser curvature, GE junction, and pylorus to maintain function and reduce the risk of reflux.
Upon completion of suturing, the stomach appeared tubular with a marked reduction in volume and a narrowed lumen, consistent with an endoscopic sleeve. The stomach was gently decompressed. The endoscope and suturing device were removed.
What documentation is required to confirm that an ESG procedure was performed?
The procedures performed endoscopic with suture gastroplasty to reduce stomach size and restrict food intake. No incisions are made into the abdomen
is ESG Considered bariatric surgery?
No. ESG is an endoscopic bariatric procedure
is there any CPT code for Endoscopic sleeve gastroplasty
CPT 43889 is now used to report Endoscopic sleeve gastroplasty performed for gastric volume reduction as a bariatric endoscopic procedure.
