Gastroenterology Coding Alert
Stretta Coverage Is Still Spotty
Question: My Stretta claims face inconsistent coverage from payers. Is there a reason for this?
Illinois Subscriber
Answer: Some payers are refusing coverage for the popular Stretta procedure, an endoscopic treatment for GERD. The procedure remains controversial in the medical community because there's no data on long-term effects.
CPT introduced 43257 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastro-esophageal reflux disease) this year, replacing Category III code 0057T.
Medicare payer Noridian, for just one example, has released a draft local coverage determination stating that it won't pay for 43257 under any circumstances. Specifically, the payer will consider the Stretta procedure -not yet proven effective- until more clinical data comes in.
Gastroenterology Coding Alert
- Endoscopy vs. Manipulation:
Here's Your Guide To Upper GI Dilations
You may report fluoroscopic guidance in many cases
When reporting upper GI dilation procedures, you won't [...] - You Be the Coder:
Can We Code PEG Tube Removals?
Question: How can I report removal of a PEG tube?
[...] - Expect a New Year Makeover For Consult Coding
Turn to 99231-99233 and 99311-99313 for same-stay follow-ups
The AMA will streamline consultation coding for [...] - Billing Consults? Here Are the Requirements
Before you report any consult service in the range 99241-99255, the physician must document these [...] - Easy Inpatient Consult Coding In Just 3 Steps
Re-admission can mean another -initial- consultation
When reporting inpatient consultations, remember that not all facility settings [...] - READER QUESTIONS:
21 Provides an Alternative to Prolonged Services - READER QUESTIONS:
Look for a '1' Indicator to Unbundle NCCI
Question: How do I know if I can -unbundle- NCCI edits? Do I need to [...] - READER QUESTIONS:
Expect Reduced Payment for Multiple Endoscopes
Question: How should I report sigmoidoscopy with tumor removal, followed by control of bleeding at [...] - READER QUESTIONS:
Stretta Coverage Is Still Spotty
Question: My Stretta claims face inconsistent coverage from payers. Is there a reason for this?
Illinois [...] - READER QUESTIONS:
Count Out Conscious Sedation
Question: I-ve heard rumors that CPT now bundles conscious sedation to endoscopic procedures. Is there [...] - READER QUESTIONS:
Keep This List Handy for 'High Risk'
Question: Which ICD-9 codes prove medical necessity for Medicare's high-risk colorectal cancer screening exam?
Missouri Subscriber
Answer: [...]
