Gastroenterology Coding Alert

Recall means you won't likely access 0133T

CPT 2006 adds 0133T to describe implant injections to the lower esophageal sphincter for treatment of GERD (gastrointestinal esophageal reflux disease), but recent events leave the future of these procedures in doubt.

Good News -
 
Beginning Jan. 1, you would have been able to report Enteryx using category III code 0133T (Upper gastrointestinal endoscopy, including esophagus, stomach, and either the duodenum and/or jejunum as appropriate, with injection of implant material into and along the muscle of the lower esophageal sphincter [e.g., for treatment of gastroesophageal reflux disease]). GI practices have waited several years for this development, and the 2006 CPT manual adds a parenthetical note to its upper GI endoscopy portion (43235-43259) specifically directing coders, -For upper gastro-intestinal endoscopy with injection of implant material into and along the muscle of the lower esophageal sphincter, use Category III code 0133T.-

How it works: Enteryx is a polymer that physicians inject directly into the walls of the esophagus. The polymer thickens and helps to block acid from flowing upward from the stomach. The physician passes the endoscope down through the mouth into the esophagus and injects the solution into the sphincter muscle using a small needle. 

Bad News -
 
On Sept. 23, Boston Scientific, the makers of Enteryx, issued an indefinite recall. A company statement stresses that the recall -is not related to the safety of the Enteryx product,- but rather -based on the procedural injection technique.-

According to chief of endoscopy at Beth Israel Deaconess Medical Center, Ram Chuttani, MD, performing the Enteryx procedure is very technically demanding. He told the Associated Press that although his hospital has done 40 to 50 of the Enteryx procedures, -it is quite difficult to control even in the best settings. Even in experienced hands when you inject, you cannot be absolutely certain where the Enteryx is injected.-

According to a Boston Scientific statement, not only do physicians have difficulty knowing if they have injected the Enteryx correctly, -there have been a limited number of injections through the wall of the esophagus that were undetected at the time of the procedure and resulted in adverse effects. Boston Scientific considers this an unacceptable risk and has elected to recall these products.- Company spokesman Paul Donovan stressed that Boston Scientific has no evidence of longer-term complications.

In short: Code 0133T is available, but you won't be reporting it anytime soon. Enteryx is the only product at this time that meets the definition of 0133T, and Enteryx is off the market until further notice.