ASGE JGES Advanced ESD | September 2022-Draganov_ESD Reimbursement Quality Metrics

Draganov_ESD Reimbursement Quality Metrics

Pdf Summary

Reimbursement for physicians performing Endoscopic Submucosal Dissection (ESD) currently lacks a unique CPT code, requiring the use of unlisted codes for billing. Specific unlisted codes are available for different procedures in various anatomical sites. Physicians should submit a cover letter with the claim to explain the procedure's nature, equipment required, estimated practice cost, and a comparison of physician work with other services. Literature support should also be provided. On the other hand, hospitals can use HCPCS Code C9779 to report ESD procedures performed in outpatient settings, but the reimbursement amount is only $2,443.39. Boston Scientific offers pre-authorization support and it is recommended to communicate with local representatives for industry support in reimbursement matters.<br /><br />Proposed quality metrics for ESD include indications for ESD, use of morphological criteria for lesion evaluation, en bloc/R0/oncologically curative resection rates, histology, technique used, complications, volume of ESDs performed per year, lesion location, need for surgery after successful ESD, and time taken to perform the procedure. Pitfalls in achieving successful ESD outcomes include factors such as operator technique, device availability, lesion selection, limited chromoendoscopy options, limited availability of magnification endoscopy, pressure to perform ESD, and prior endoscopic interventions.<br /><br />It is highlighted that ESD techniques and outcomes may differ between Japan and the United States, with Japan having higher en bloc resection rates in colorectal ESD cases. In summary, physicians should use unlisted codes for billing with appropriate support and be prepared to appeal rejections. Facilities can use HCPCS Code C9779 for billing. Currently, there are no established quality metrics, but considerations include en bloc/R0/oncologically curative resection rates and complications.

Keywords

Endoscopic Submucosal Dissection

Reimbursement

CPT code

Unlisted codes

Billing

Cover letter

HCPCS Code C9779

Pre-authorization support

Quality metrics

ESD outcomes