Gastroenterology Coding Alert

Answer: The Stretta radio frequency technique is a new endoscopic procedure for treating gastroesophageal reflux disease (GERD). The new technique is a minimally invasive procedure that treats the lower esophageal sphincter (LES) with a dosage of radio-frequency energy, which tightens the LES and stops the flow of stomach acid into the esophagus.

There is no CPT code for the Stretta technique, according to Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT Advisory Panel. Although the Food and Drug Administration (FDA) approved the procedure for use on patients last spring, that approval was based on data showing that the Stretta procedure would help reduce GERD for at least six months after treatment. Until the long-term outcomes of this procedure are evaluated, most gastroenterologists will probably stick with proven treatment options such as proton pump inhibitors and other acid-suppression medications.

This procedure will probably be assigned a category III emerging technology code in CPT 2002, Weinstein believes. Category III codes will represent new emerging medical technologies that are going through or have just finished the FDA approval process. The purpose of this category is to allow for the accumulation of research and data on the use and frequency of these new procedures. These codes will be assigned an alphanumeric identifier to differentiate them from the category I codes, which are the codes now contained in CPT 2001.

If you want to report a CPT code, Weinstein suggests that you use the unlisted code for the esophagus (43499). Whenever an unlisted code is reported, the gastroenterologist needs to provide a copy of the operative report and a separate statement that mentions the steps taken during the Stretta procedure, the time taken to complete it and a listed service that is its closest equivalent.

Because this is a new technique, Weinstein believes that Medicare and most private payers are probably not aware of the procedure, and you may have to contact your payer to discuss whether you will be reimbursed.