Cargando…

Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America

Endoscopic submucosal dissection (ESD) and related procedures are minimally invasive and cost-effective alternates to surgery. However, there is no approved or listed current procedural terminology (CPT) for ESD. We aimed to review the current reimbursement process hurdles for ESD procedures in priv...

Descripción completa

Detalles Bibliográficos
Autores principales: Iqbal, Shahzad, Ali, Aman, Razzaq, Arham, Shahzad, Eman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939120/
https://www.ncbi.nlm.nih.gov/pubmed/31942234
http://dx.doi.org/10.4253/wjge.v12.i1.49
_version_ 1783484174574813184
author Iqbal, Shahzad
Ali, Aman
Razzaq, Arham
Shahzad, Eman
author_facet Iqbal, Shahzad
Ali, Aman
Razzaq, Arham
Shahzad, Eman
author_sort Iqbal, Shahzad
collection PubMed
description Endoscopic submucosal dissection (ESD) and related procedures are minimally invasive and cost-effective alternates to surgery. However, there is no approved or listed current procedural terminology (CPT) for ESD. We aimed to review the current reimbursement process hurdles for ESD procedures in private practice model in United States. We reviewed the data of two advanced endoscopists (one in New York and other in Pennsylvania State) performing ESD in their private practice set-ups. We found the reimbursement process was complex, with number of refusals varied from 0-9 for ESD procedures. It was not paid at all in 8.3% of cases by the medical insurance. Endoscopic mucosal resection, which is considered inferior as compared to ESD, but has a listed CPT, was denied in only 0.83% cases. Our data highlights the billing hurdles by the endoscopists to adopt ESD-related procedures in private practice model.
format Online
Article
Text
id pubmed-6939120
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Baishideng Publishing Group Inc
record_format MEDLINE/PubMed
spelling pubmed-69391202020-01-16 Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America Iqbal, Shahzad Ali, Aman Razzaq, Arham Shahzad, Eman World J Gastrointest Endosc Letter To The Editor Endoscopic submucosal dissection (ESD) and related procedures are minimally invasive and cost-effective alternates to surgery. However, there is no approved or listed current procedural terminology (CPT) for ESD. We aimed to review the current reimbursement process hurdles for ESD procedures in private practice model in United States. We reviewed the data of two advanced endoscopists (one in New York and other in Pennsylvania State) performing ESD in their private practice set-ups. We found the reimbursement process was complex, with number of refusals varied from 0-9 for ESD procedures. It was not paid at all in 8.3% of cases by the medical insurance. Endoscopic mucosal resection, which is considered inferior as compared to ESD, but has a listed CPT, was denied in only 0.83% cases. Our data highlights the billing hurdles by the endoscopists to adopt ESD-related procedures in private practice model. Baishideng Publishing Group Inc 2020-01-16 2020-01-16 /pmc/articles/PMC6939120/ /pubmed/31942234 http://dx.doi.org/10.4253/wjge.v12.i1.49 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Letter To The Editor
Iqbal, Shahzad
Ali, Aman
Razzaq, Arham
Shahzad, Eman
Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America
title Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America
title_full Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America
title_fullStr Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America
title_full_unstemmed Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America
title_short Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America
title_sort lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in north america
topic Letter To The Editor
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939120/
https://www.ncbi.nlm.nih.gov/pubmed/31942234
http://dx.doi.org/10.4253/wjge.v12.i1.49
work_keys_str_mv AT iqbalshahzad lackofproperreimbursementishamperingadoptionofminimallyinvasivegastrointestinalendoscopyinnorthamerica
AT aliaman lackofproperreimbursementishamperingadoptionofminimallyinvasivegastrointestinalendoscopyinnorthamerica
AT razzaqarham lackofproperreimbursementishamperingadoptionofminimallyinvasivegastrointestinalendoscopyinnorthamerica
AT shahzademan lackofproperreimbursementishamperingadoptionofminimallyinvasivegastrointestinalendoscopyinnorthamerica