ASGE Advanced Endoscopic Lesion Resection Course (On-Demand) | November 2022-The Economics of Endoscopic Resection: Making the Finances Work

Video Transcription

Video Summary

The speaker begins by acknowledging that they expected to give a talk on an exciting topic, but instead will be discussing the economics of endoscopic resection and how to make the finances work. They disclose they have no financial conflicts of interest and are not from a finance background. They highlight the available resources for billing, such as Medicare's payment fee schedules and society and industry resources. The speaker then shares research on colonoscopies and colon polyps in the US, including the finding that endoscopic resection is cost-effective and associated with fewer adverse events compared to surgical resection. They discuss the definition of an advanced endoscopist and emphasize that endoscopic resection is generally more cost-effective. They mention that while surgery is increasing, there is a shift towards fewer surgeries for malignancies and more for non-malignant colon polyps. The speaker suggests considering what is the least invasive and most cost-effective way to manage individual polyps and discusses the assumptions they will make in their talk. They emphasize the importance of understanding what the community needs in order to expand one's practice or determine the best approach to managing patients' polyps. The speaker discusses the skill set and training required for endoscopic resection, including industry-supported programs and international courses. They mention the lack of standardized training for endoscopic submucosal dissection (ESD) in the US and the need for substantial investment in time and resources to acquire proficiency in ESD. The speaker then delves into billing and payment for endoscopic procedures, discussing CPT codes, ambulatory payment classification groups (APCs) , diagnosis-related groups (DRGs) , and ambulatory surgical center (ASC) billing and payment. They mention modifiers, including the 22 modifier, which requires appropriate documentation to justify additional work and potentially increase reimbursement. The speaker highlights the importance of considering the location of procedures, payer mix, and local payment agreements when determining reimbursement rates. They briefly touch on billing for ESD and suggest including a cover letter and providing data to support reimbursement claims. The speaker ends by emphasizing the need to carefully consider the cost, resources, and reimbursement associated with endoscopic resection practices, and to work with administration and referral bases to support practice growth and innovation.

Asset Subtitle

Adam W. Templeton, MD, FASGE

Keywords

endoscopic resection

billing

cost-effectiveness

training

reimbursement

practice growth