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2011 Coding and Reimbursement Guide for Endoscopy Procedures Involving the Naviaid ™ AB and Naviaid ™ABC Devices

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2011 Coding and Reimbursement Guide for Endoscopy Procedures Involving the Naviaid ™ AB and Naviaid ™ABC Devices 2011 Coding and Reimbursement Guide for Endoscopy NaviAid ™AB NaviAid ™ABC Procedures Involving the and Devices DESCRIPTION OF PAYMENT METHODS Physician Billing and Payment Medicare payment for inpatient hospital services is based Medicare and most other insurers typically reimburse on a classification system determined by patient physicians based on fee schedules according to CPT diagnosis known as Medicare Severity - Diagnosis Codes. The CPT Codes are published by the American Related Groups (MS-DRGs). MS-DRGs are based on the Medical Association (AMA) and are used to report assumption that economic incentives can be used to medical procedures and services under public and private improve hospital efficiency, thus containing health care health insurance programs. expenditures. Fixed prices are established for hospital services based on the patient’s diagnosis and are paid regardless of the actual cost the hospital incurs in providing these services. Only one MS-DRG is assigned Hospital Outpatient Billing and Payment to a patient for a particular hospital admission. Therefore, one payment is made per patient and that payment is A hospital outpatient department is administratively and based upon the MS-DRG assignment. financially linked to a hospital and the services are performed for patients who are registered at the hospital A sampling of MS-DRGs that may apply to procedures but are not admitted as an inpatient, i.e. .no overnight involving the use of the NaviAid™ AB and NaviAid™ ABC stay. devices are as follows: The Hospital Outpatient Prospective Payment System is based on groups of procedures, medical visits, and MS- MS-DRG ancillary services referred to as Ambulatory Payment DRG Description Rate 2 Classifications (APCs). The services within each group 326 Stomach, Esophageal & Duodenal Procedures W MCC $32,467.23 are similar clinically and in relative resource use. 327 Stomach, Esophageal & Duodenal Procedures W CC $15,206.35 Assignment of APC grouping is based on CPT codes. 328 Stomach, Esophageal & Duodenal Procedures W/O CC/MCC $ 7,984.12 329 Major Small & Large Bowel Procedures W MCC $29,488.24 330 Major Small & Large Bowel Procedures W CC $14,423.81 Hospital Inpatient Billing and Payment 331 Major Small & Large Bowel Procedures W/O CC/MCC $ 9,083.84 344 Minor Small & Large Bowel Procedures W MCC $17,638.26 ICD-9-CM procedure codes 1 are used to report 345 Minor Small & Large Bowel Procedures W CC $ 9,512.81 procedures performed in a hospital inpatient setting. The following are a few of the ICD-9-CM procedure codes that 346 Minor Small & Large Bowel Procedures W/O CC/MCC $ 6,635.45 may be appropriate for the procedures involving the use 374 Digestive Malignancy W MCC $11,544.33 of NaviAid™ AB and NaviAid™ ABC devices: 375 Digestive Malignancy W CC $ 7,148.29 376 Digestive Malignancy W/O CC/MCC $ 4,734.28 Procedure Description CC = Complications and Comorbidites Code MCC = Major Complications and Comobidites 44.32 Percutaneous [endoscopic] gastrojejunostomy 44.43 Endoscopic control of gastric or duodenal bleeding 45.13 Other endoscopy of small intestine 45.14 Closed [endoscopic] biopsy of small intestine Ambulatory Surgical Centers (ASC) Billing and 45.16 Esophagogastroduodenoscopy (EGD) with closed Payment biopsy 45.23 Colonoscopy An Ambulatory Surgical Center is a free-standing clinic 45.25 Closed [endoscopic] biopsy of large intestine outside the hospital setting. As in the hospital outpatient 45.30 Endoscopic excision or destruction of lesion of duodenum setting payment system, the ASC payment system is also 45.42 Endoscopic polypectomy of large intestine based on the APC grouping. Medicare has a list of 45.43 Endoscopic destruction of other lesion or tissue of services that are covered in the ASC setting. Not all large intestine services that Medicare covers in the hospital outpatient 46.32 Percutaneous (endoscopic) jejunostomy (PEJ) setting are eligible for payment in ASCs. 46.79 Other repair of intestine 46.85 Dilation of intestine 46.86 Endoscopic insertion of colonic stent(s) 51.10 Endoscopic retrograde cholangiopancreatography [ERCP] Providers should select the most appropriate procedure code(s) to describe the services provided to the patient. DISCLAIMER: THE INFORMATION PROVIDED WITH THIS NOTICE IS GENERAL REIMBURSEMENT INFORMATION ONLY AS OF APRIL 2011; IT IS NOT LEGAL ADVICE, NOR IS IT ADVICE ABOUT HOW TO CODE, COMPLETE OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. ALTHOUGH WE SUPPLY THIS INFORMATION ACCORDING TO OUR CURRENT KNOWLEDGE, IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS AND BILLS FOR THE SERVICES THAT WERE RENDERED. THIS INFORMATION IS PROVIDED AS OF THE DATE LISTED ABOVE, AND ALL CODING AND REIMBURSEMENT INFORMATION IS SUBJECT TO CHANGE WITHOUT NOTICE. REIMBURSEMENT INFORMATION PROVIDED BY SMART MEDICAL SYSTEMS LTD. IS GATHERED FROM THIRD-PARTY SOURCES AND PRESENTED FOR ILLUSTRATIVE PURPOSES ONLY. PAYERS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS AND POLICIES. BEFORE FILING ANY CLAIMS, PROVIDERS SHOULD VERIFY CURRENT REQUIREMENTS AND POLICIES WITH THE PAYER. MEDICARE PHYSICIAN, HOSPITAL OUTPATIENT AND ASC PAYMENT The following are the CPT codes that may apply when procedures using the NaviAid™ AB and NaviAid™ ABC devices are performed. Also included are the 2011 national Medicare Physician Fee Schedule (MPFS), Hospital Outpatient Ambulatory Payment Category (APC) and Ambulatory Surgical Center (ASC) payment rates. Payment will vary in geographic locality. 2011 Medicare Reimbursement (National Average) CPT 3 Code Descriptions Physician Facility Code 4 5 Hospital 7 Office Facility 6 ASC Outpatient UPPER ENDOSCOPY / ENTEROSCOPY / ILEOSCOPY Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or 43235 $297.97 $148.14 $611.73 $344.10 without collection of specimen(s) by brushing or washing (separate procedure) Upper gastrointestinal endoscopy including esophagus, stomach, and 43236 either the duodenum and/or jejunum as appropriate; with directed $369.32 $179.00 $611.73 $344.10 submucosal injection(s), any substance Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic 43237 $240.55* $240.55 $611.73 $344.10 ultrasound examination limited to the esophagus Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with 43238 transendoscopic ultrasound-guided intramural or transmural fine $300.01* $300.01 $611.73 $344.10 needle aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination limited to the esophagus) Upper gastrointestinal endoscopy including esophagus, stomach, and 43239 either the duodenum and/or jejunum as appropriate; with biopsy, single $345.20 $174.64 $611.73 $344.10 or multiple Upper gastrointestinal endoscopy including esophagus, stomach, and 43240 either the duodenum and/or jejunum as appropriate; with transmural $405.00* $405.00 $611.73 $344.10 drainage of pseudocyst Upper gastrointestinal endoscopy including esophagus, stomach, and 43241 either the duodenum and/or jejunum as appropriate; with $158.67* $158.67 $611.73 $344.10 transendoscopic intraluminal tube or catheter placement Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided intramural or transmural fine 43242 $432.52* $432.52 $1,148.75 $646.18 needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum and/or jejunum as appropriate) Upper gastrointestinal endoscopy including esophagus, stomach, and 43243 either the duodenum and/or jejunum as appropriate; with injection $273.17* $273.17 $611.73 $344.10 sclerosis of esophageal and/or gastric varices Upper gastrointestinal endoscopy including esophagus, stomach, and 43244 either the duodenum and/or jejunum as appropriate; with band ligation $301.71* $301.71 $611.73 $344.10 of esophageal and/or gastric varices Upper gastrointestinal endoscopy including esophagus, stomach, and 43245 either the duodenum and/or jejunum as appropriate; with dilation of $191.97* $191.97 $611.73 $344.10 gastric outlet for obstruction (eg, balloon, guide wire, bougie) Upper gastrointestinal endoscopy including esophagus, stomach, and 43246 either the duodenum and/or jejunum as appropriate; with directed $256.86* $256.86 $611.73 $344.10 placement of percutaneous gastrostomy tube Upper gastrointestinal endoscopy including esophagus, stomach, and 43247 either the duodenum and/or jejunum as appropriate; with removal of $204.54* $204.54 $611.73 $344.10 foreign body 2 2011 Medicare Reimbursement (National Average) CPT 3 Code Descriptions Physician Facility Code 4 5 Hospital 7 Office Facility 6 ASC Outpatient Upper gastrointestinal endoscopy including esophagus, stomach, and 43248 either the duodenum and/or jejunum as appropriate; with insertion of $192.31* $192.31 $611.73 $344.10 guide wire followed by dilation of esophagus over guide wire Upper gastrointestinal endoscopy including esophagus, stomach, and 43249 either the duodenum and/or jejunum as appropriate; with balloon $177.36* $177.36 $611.73 $344.10 dilation of esophagus (less than 30 mm diameter) Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of 43250 $192.65* $192.65
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