Wiki esophyx

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becka95

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Anyone have experience with the Esophyx procedure? We are trying to get some information on coding the procedure and reimbursement. The hospital has purchased the equipment but now the next step is how to code/bill for it. We are not having much luck going through the vendor. Any information or a point in the right direction would be greatly appreciated!
 
What an interesting procedure! I had to watch a couple videos on the internet to get a good grasp of what they do....fascinating! Anyway, I would think you may need to use a 43499 (unlisted) code for this as it's not diagnostic but an incision-less repair via endoscopy. I didn't find anything else to fit. Then, of course, you'll have to send the report with the claim. I'd love to hear back as to reimbursement issues you encounter.
 
We have been doing the transoral incisionless fundoplication with Esophyx since November of 2008. I do the billing for the doctor and use the unlisted as was mentioned above 43499, the facility uses C9724. Medicare, Blue Cross, and Humana all have denied as experimental but we have several patients who are willing to pay out of pocket. Dr. Barnes is going to a convention soon and is presenting a study he has been compiling for the past year. He really believes in the procedure and is working towards getting a cpt code. I believe there are several doctors around the U.S. doing the procedure but billing incorrectly with the 43324-52
 
Would you be willing to give us information on what your provider finds out at the convention? I have a doc who just recently began doing this procedure. I've been told that I should use the 43499 unlisted code, but we really don't know how to come up with a comparison RVU for the procedure. I'm unsure of how to bill for it correctly. Any help would be appreciated.
 
Treetoad said:
Would you be willing to give us information on what your provider finds out at the convention? I have a doc who just recently began doing this procedure. I've been told that I should use the 43499 unlisted code, but we really don't know how to come up with a comparison RVU for the procedure. I'm unsure of how to bill for it correctly. Any help would be appreciated.
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I have two doctors who are starting this procedure. I haven't been able to find a comparison code either, but after reading some of the above posts, i wonder if we could use the C9724 as the comp code even though it is facility oriented?
 
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