Wiki TIF Procedure (Transoral Incisionless Fundiplication

Create Wiki
G

gniedermaier

Guest
Messages
9
Best answers
0
Looking for any additional information regarding reimbursement of this procedure in Michigan. Initially we were billing with an unlisted code of 43499 - Unlisted Procedure, Esophagus which was denied. We have been advised by others that they have been billing with 43280 - Laparoscopy, surgical, esophagogastric fundoplasty (Nissen, Toupet procedures). Does anyone else have any other suggestions?

Thank You,

Gina Niedermaier, CMC
 
Since this is not a laparoscopic procedure, it would be incorrect to charge it as if it were. You are correct in charging with the unlisted code. You may be able to appeal the denied claims with notes. Currently, there is no specific code for this procedure.
 
I've been doing a lot of research on this as our physician just started doing this procedure. We are also using 43499 but are expecting denials. I have not found a carrier yet (BCBS, MCR, Humana, United Healthcare, Greatwest/Cigna) that will cover the TIF because they still consider it experimental. Each of their websites have specific policies stating TIF is not a covered benefit. We are having all of our patients sign ABN's and/or making them aware that insurance will probably deny & they will be responsible for payment.
Our physician was pretty much guaranteed by the reps that there wouldn't be any problem with reimbursement from insurances for this. Since we're having problems he has contacted the rep for help on how to get paid, but as of today we have heard nothing back.
Sadie, CPC
 
CPT Assistant June 2011 / Volume 21 Issue 6

Coding Tip
There is no specific CPT code for transoral incisionless fundoplasty (TIF). CPT code 43659, Unlisted laparoscopy procedure, stomach, should be reported.
 
Not that it makes a huge difference but there was a coding correcting on that in CPT Assistant 12/11 Volume 21 Issue 12 p.19

Coding Correction
"The correct statement should read: An Endoscopic transoral incisionless fundoplication is reported using code 43499, Unlisted procedure, esophagus."
 
You can't use 43659 since this is not a laparoscopic procedure. It is an endoscopic procedure.

This should be coded with an unlisted code as this is how CPT codes are developed. Once enough unlisted codes are submitted then they realize there's a need for a code and then a T code is developed. Once enough literature has been published, a Category III code (T code) is changed to a Category I code.
 
You must log in or register to reply here.
Top