Otolaryngology Coding Alert

Question: Can we receive payment for endosheaths?

Kansas Subscriber

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.



Answer: An endosheath is a disposable sheath that covers and protects the working surfaces of an endoscope from contamination by providing a sterile, disposable barrier that slides on the scope before the patient is examined and slides off after the exam is completed.

Although Medicare provides a HCPCS code (A4270, disposable endoscope sheath, each) for the supply of the endosheath, HCFA considers it a noncovered supply and Medicares fee schedule assigns it zero relative value units. Private payers may, however, reimburse for the sheath, says Michelle Logdson, CPC, CCS-P, an otolaryngology coding and reimbursement specialist in Bayville, N.J.

Many practices use endosheaths in spite of the difficulty obtaining payment because they are cost-effective. By reducing the damage that can occur to endoscopes, the endosheath saves significant expenditure for scope repair contracts. The reduction in repairs far outweighs the cost of the endosheaths (which are disposed of after every endoscopic procedure). In addition, the endosheath saves downtime between procedures by minimizing manual cleaning and disinfection processes, and reduces overhead costs by eliminating the need to maintain a backup inventory of endoscopes.