ASGE/JGES Advanced ESD (Live and Virtual) | July 16-17 2023-Reimbursement & Quality Metrics

Video Transcription

Video Summary

In this video, the speaker discusses reimbursement and quality metrics for endoscopic submucosal dissection (ESD). They explain that reimbursement at their hospital in Maryland is different from other hospitals in different states. To submit claims for physician reimbursement, it is recommended to use unlisted codes, which end with 99 and vary for each organ. The speaker suggests submitting a predetermination letter to insurance companies to confirm reimbursement for procedures like ESD, which may be considered experimental or investigational. They outline the contents of the letter, including patient information, lesion characteristics, rationale for choosing ESD, and supporting clinical studies. The speaker also mentions that facility reimbursement codes have been updated and discusses the payment rates. In terms of quality metrics, they explain the importance of recording and monitoring indicators such as on-block resection rates, curative resection rates, complications, and procedure time. They highlight the need for using both morphology criteria and enhanced imaging for accurate diagnosis. The speaker encourages monitoring individual performance and referencing guidelines and clinical practice updates. They also discuss the technique terminology for ESD and recommend tracking procedure volume and time to assess proficiency. The speaker concludes by emphasizing the need to establish and monitor quality metrics despite the lack of universally accepted standards.

Asset Subtitle

Saowanee Ngamruengphong, MD, FASGE

Keywords

reimbursement

quality metrics

endoscopic submucosal dissection

predetermination letter

facility reimbursement codes