ASGE/JGES Advanced ESD (Live and Virtual)| July 14-15 2023-Reimbursement & Quality Metrics

Video Transcription

Video Summary

The video transcript discusses reimbursement and quality metrics related to ESD (endoscopic submucosal dissection). The speaker explains that reimbursement for ESD is different in Maryland compared to other states, and they seek to learn from the experiences of other faculty members. They outline the reimbursement process for physician and facility fees, recommending the use of unlisted codes for physician reimbursement. They also suggest submitting a predetermination letter to insurance companies to determine the amount to be paid for the procedure. The speaker emphasizes the importance of proper documentation, including patient information specific to the procedure, and the need to submit additional clinical studies to support the reimbursement request. They also explain the new facility code for ESD procedures and note that the payment has increased by about 30% from the previous year. The video also highlights the absence of commonly accepted quality metrics for ESD but recommends tracking and recording various factors such as indications, resection outcomes, complications, and procedure time. They advise using both morphology criteria and enhanced imaging to improve accuracy in diagnosing cancer and also stress the significance of tracking on-block resection rates, R0 resection rates, and curative resection rates. They conclude by mentioning the need to track volume of ESD cases per year and procedure time as they correlate with outcomes. The speaker suggests using unlisted codes, considering predetermination letters, and following society recommendations for billing purposes.

Asset Subtitle

Saowanee Ngamruengphong, MD, FASGE

Keywords

reimbursement

quality metrics

endoscopic submucosal dissection

Maryland

unlisted codes