Gastroenterology Coding Alert

Question: One of our GI physicians is using ELGP to treat GERD. How should we code for this?


California Subscriber
Answer: Endoluminal gastroplication (ELGP, also known as endoscopic fundoplication) is an emerging technique for treating GERD (gastroesophageal reflux disease). The procedure involves using the Bard EndoCinch to reduce the size of the opening from the stomach into the esophagus, rendering the lower sphincter more functional.

Now the only way to report ELGP is with category III code 0008T (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate, with suturing of the esophagogastric junction).
 
Category III codes are temporary codes that describe emerging technology, services and procedures. Many payers will not reimburse category III codes because they think the procedures are not proven effective.

The primary purpose of these codes is to allow for data collection, which in turn provides information for evaluating the effectiveness of new technologies and the formation of public and private policy. In other words, category III codes give insurers and government policy- makers a way to track the effectiveness and rate-of-use of as-yet-unproven technologies, which could affect future coverage decisions.

The designation of a category III code is an important first step in wider adoption of new technology and the eventual creation of a category I CPT code to describe the service (although this doesn't happen in every case).

Important: When a category III code exists to describe a service or procedure, you must use that category III code--rather than an unlisted-procedure code--to describe the service when placing a claim.