Get Reimbursed for Stretta Procedure With Four Crucial Steps
Published on Sun Apr 01, 2001
The Stretta procedure is a relatively new treatment for gastroesophageal reflux disease (GERD) that is beginning to be reimbursed by some payers. No new codes have been created to describe the procedure, but existing CPT codes are gaining reimbursement for many gastroenterologists.
Gastroenterologists, however, must be careful to apply the correct diagnosis code and obtain precertification with carriers for the procedure.
Some payers are still being cautious, but for the most part they recognize that the procedure has been successful, and we arent having much trouble getting our claims reimbursed, says Mark Noar, MD, a gastroenterologist in Towson, Md., who has performed the Stretta procedure over 70 times in the past six months.
FDA Approved Stretta for GERD
The Food and Drug Administration (FDA) approved the procedure in April 2000 for the electrosurgical coagulation of tissue and it is intended for use specifically in the treatment of gastroesophageal reflux disease, according to official documents from the agency.
The Stretta procedure, which is performed with special equipment manufactured by Curon Medical, is a minimally invasive treatment using radio-frequency energy to treat patients with symptomatic GERD by destroying the nerve-afferent pathways believed to be responsible for the reflux. Everyone has reflux, but when a patient has GERD, the sphincter muscle is constantly relaxing and causing constant reflux, Noar says. You have to have a nerve impulse for the muscle to relax and loosen. When there is a lack of nerve impulses, the muscle tightens.
An upper gastrointestinal endoscopy is first performed to visualize the esophagus and upper gastrointestinal tract, Noar continues. The scope is then removed and an endoscopic catheter with a balloon at the tip is inserted into the patient. The balloon is inflated, and needles containing radio-frequency probes are deployed into the mucosa. The radio-frequency energy turns to heat, creates a burn 1 to 2 millimeters in size, and destroys some of the nerve-afferent pathways. The catheter is retracted and repositioned before the process is repeated. About 40 to 80 burns are created in one session, ablating nerves in both the lower esophageal sphincter AND the cardia.
1. Report 64640 Twice
Gastroenterologists should use the following codes when reporting the Stretta procedure, according to Karin Bolinger, director of reimbursement at Curon Medical, headquartered in Sunnyvale, Calif.
Code 43258 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique) should be used to report the upper gastrointestinal endoscopy. Code 64640 (destruction by neurolytic agent; other peripheral nerve or branch) should be used to report the destruction of nerves in the lower esophageal sphincter. To [...]
