ASGE JGES Advanced ESD (On-Demand) | September 2022 OLESDSEPT22ADV-Reimbursement and Quality Metrics in ESD

Video Transcription

Video Summary

In this video, the speaker discusses reimbursement for physicians and facilities for endoscopic submucosal dissection (ESD) procedures. The speaker explains that there is no dedicated Current Procedural Terminology (CPT) code for ESD, so the recommendation is to use an unlisted code for physician reimbursement. However, this often leads to rejections and denials, requiring an appeal process. The speaker advises preparing a letter for the appeal that includes details about the procedure, required equipment, estimated practice cost, and a comparison of physician work to other procedures with reimbursement codes. The speaker also suggests providing literature support and using an expert review paper as a reference. For facility reimbursement, there is a newly created code (C9779) for reporting ESD performed in an outpatient setting, but the reimbursement amount is relatively low. The speaker encourages submitting unlisted codes to track the number of ESD procedures and justify the need for a dedicated code. The speaker briefly touches on quality metrics for ESD and the challenges of determining the number of ESDs being done.

Asset Subtitle

Peter Draganov, MD

Keywords

reimbursement

endoscopic submucosal dissection

unlisted code

physician work

facility reimbursement