ASGE JGES Advanced ESD (On-Demand) | September 2022 OLESDSEPT22ADV-Draganov

Draganov_ESD Reimbursement Quality Metrics

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In this document, Dr. Peter Draganov discusses reimbursement and quality metrics for Endoscopic Submucosal Dissection (ESD). He notes that currently, there are no unique CPT codes for ESD procedures, so physicians should use unlisted codes for billing. He provides a list of unlisted codes for different anatomical sites. To increase the likelihood of reimbursement, physicians should submit a cover letter with the claim that explains the procedure's nature, required equipment, estimated practice cost, and a comparison of physician work with other comparable services.<br /><br />For facilities, a newly created HCPCS code, C9779, can be used to report ESD procedures performed in the outpatient setting, but the reimbursement for this code is only $2,443.39. Dr. Draganov mentions that Boston Scientific offers pre-authorization support and recommends speaking with local representatives for industry support with reimbursement.<br /><br />He also proposes several quality metrics for ESD procedures, including indications for ESD, use of morphological criteria for lesion evaluation, en bloc/R0/oncologically curative resection rates, histology evaluation, and the technique used. He also suggests measuring complications, volume of ESDs performed per year, lesion location, the need for surgery after successful ESD, and the time taken to perform the procedure.<br /><br />Dr. Draganov highlights some pitfalls in ESD, such as the dependence on factors like operator technique, device availability, and lesion selection. He also mentions limited options for chromoendoscopy and magnification endoscopy. He notes the pressure to perform ESD, especially with recurrent lesions, tattooed lesions, and prior endoscopic interventions.<br /><br />In summary, Dr. Draganov recommends using unlisted codes for physician billing and providing support for the billing process. For facility billing, the HCPCS code C9779 should be used. He emphasizes the need for established quality metrics, particularly evaluating en bloc/R0/oncologically curative rates and complications.

Keywords

Endoscopic Submucosal Dissection

reimbursement

quality metrics

unlisted codes

billing

HCPCS code

physician work

complications

lesion location

procedure time