Wiki TIF - Transoral incisionless fundoplication

Create Wiki
P

pkidd

Networker
Local Chapter Officer
Messages
61
Location
Albany, OR
Best answers
0
Hello Fellow Codes,

I need help please -
Is anyone coding for this procedure? Are you getting reimbursed?

My surgeons have done 2; 1 BCBS & 1 Medicare (Oregon/Noridian). Both have been denied. We used cpt 43499 and compared it to 43280.

Now my surgeons want me to use cpt 43280. There is an article in Gen Surg Coding Alert, that alludes to appending mod-52 to the code in lieu of an unlisted code if the procedure that was done is less complex than the existing code. Has anyone any experience with this method?

I wonder whether cpt 43281 would work; the patient did have his hiatal hernia repaired at the same time. 43281 does not specifically state that the Nissen wrap was done laparoscopically, does it? And, no, telling the surgeons that they cannot do any procedures without a cpt code does not work either!

Any assistance or advice is appreciated!
Pat Kidd, CPC, CGSC
pkidd@samhealth.org
 
The unlisted esophogus would be the only appropriate code. The others are listed as laparoscopic procedures. I am reading an op report and this is all done with a fundoplication tool sent down just like an EGD would be. It uses H fasteners with the pulling of tissue over the instrument then closing with the H clips. With no ports or openings it is not laparoscopic.
 
Tif

I also checked with the ACS coding hotline on this procedure and they said 43499 would be the appropriate code to use. Might be a good idea to have patients sign a waiver for these procedures.

Vicky Kratzer, CPC
 
Have you sent both claims back as paper claims with the OP notes?
The few times I have had to use an unlisted procedure code the claim was always denied and we had to send notes but eventually they were paid.
 
Tif

The CPT Codebook states "Do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using the appropriate unlisted procedure or service code." Kathy Gray is correct. I think the only way a code will be added is if they get enough hospitals and offices forcing insurance companies to take a hard look at surgeries being performed. Right now it's time consuming but it's the only way to bill honestly. Our patients sign waivers.
 
C9724 is quoted on an Aetna website this looks interesting also the unlisted esophagus code for 43499 these codes were also found on BCBS as well Cigna. Hope it helps!!
 
TIF Transoral Incisionless Fundoplication

None of our payers are allowing this procedure as it is still considered investigational. Our CMS Medicare contractor currently has a DRAFT policy in review. It lists the 43499 unlisted esophagus, 43999 unlisted stomach and C9724 ENDOSCOPIC FULL-THICKNESS PLICATION IN THE GASTRIC CARDIA USING ENDOSCOPIC PLICATION SYSTEM (EPS); INCLUDES ENDOSCOPY.

We originally billed some with the 43499; however, that code does not allow for an assistant surgeon. We have one of our guys assisting, so we are opting to transition to the 43999; however, BEWARE most payers are still considering this procedure investigational!

I could agree either way, but the procedure is really manipulating the stomach.

Thanks,
 
You must log in or register to reply here.
Top