ASGE JGES Advanced ESD | September 2022-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 physicians are advised to use an unlisted code for reimbursement. However, reimbursement is often denied and appeals must be submitted. The speaker recommends including a letter with the appeal, listing the nature of the procedure, equipment required, estimated practice cost, and a comparison to other procedures with reimbursement codes. The speaker also suggests providing literature support, such as an expert review on ESD. For facilities, there is a newly created CPT code (C9779) that can be used for reporting ESD procedures performed in outpatient settings. However, the reimbursement amount is relatively low. The speaker emphasizes the importance of submitting unlisted codes to track the number of ESD procedures and potentially request a dedicated CPT code in the future. The speaker also briefly discusses quality metrics for ESD, including unblock R0 and curative resection rates.

Asset Subtitle

Peter Draganov, MD

Keywords

reimbursement

endoscopic submucosal dissection

CPT code

unlisted code

quality metrics