Gastroenterology Coding Alert

Question: Our office is about to begin administering the Stretta procedure to some patients with gastroesophageal reflux disease (GERD). Even though Stretta has a permanent CPT code, I'm a little wary of payers reimbursing for it. Should we continue to get advance beneficiary notices (ABNs) before starting Stretta on our Medicare patients?


Hawaii Subscriber


Answer: CPT 2005 may have provided a code to use when a patient comes in for the Stretta procedure, but offices that don't get a signed ABN on file before starting treatment will likely be stuck with any overage on the bill.

The Stretta procedure is slowly and steadily gaining acceptance as a treatment for GERD, nailing down a permanent CPT code this year: 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 gastroesophageal reflux disease).

But it is still not considered a mainstream treatment, and many Medicare carriers still won't pay for 43257 under any circumstances. If a gastroenterologist has the patient sign the ABN before starting Stretta, however, the office can bill the patient for any portion of the Stretta tab that Medicare doesn't cover.

What should an ABN accomplish? Your office's ABN must inform the patient that it is likely that Medicare won't pay for some or all of the Stretta bill, and that any overage will be the patient's responsibility should Medicare decide not to pay.

The patient can then choose whether it's worth it to have the Stretta even if Medicare won't pay for it.