Coding for Minimally Invasive Endoscopic Treatments Are Now Available
Olympus supports the recent creation of new reimbursement billing codes for Per-oral Endoscopic Myotomy (POEM) Endoscopic Submucosal Dissection (ESD) procedures; Decision is expected to improve patient access to the minimally invasive procedure
CENTER VALLEY, Pa. (April 18, 2022) — Olympus, a global technology leader in designing and delivering innovative solutions for medical and surgical procedures, today announced its support of a new reimbursement from the Centers for Medicare and Medicaid Services that is expected to improve patient access to Endoscopic Submucosal Dissection (ESD) and for per-oral endoscopic myotomy (POEM). Both are minimally invasive procedures performed endoluminally as an alternative to open or laparoscopic surgery.
- Effective Jan. 1, 2022, a new level 1 CPT code is available for 43497, lower esophageal myotomy transoral, i.e. peroral endoscopic myotomy (POEM).1
- Additionally, effective Oct. 1, 2021, there is a new HCPCS code C9779, endoscopic submucosal dissection (ESD), including endoscopy or colonoscopy, mucosal closure, when performed.2
The issuance and availability of these POEM and ESD reimbursement billing codes will allow providers a pathway to access reimbursement, which is expected to increase patient access. POEM is an alternative to laparoscopic Heller's myotomy for the treatment of achalasia or non-relaxing lower esophageal sphincter. ESD is an established and effective treatment for GI tract lesions, including cancerous and precancerous tumors. Compared to Endoscopic Mucosal Resection (EMR), ESD allows for the complete en bloc removal rather than piecemeal resection of large tumors greater than 2 cm. The procedure offers higher rate of complete tumor removal, reducing the need for laparoscopic surgery and the risks associated with it.3
"The decision to establish coding will lead to reimbursement and coverage of these procedures and means patients will now have a greater chance at an improved quality of life," says Dr. Norio Fukami, gastroenterologist with the Mayo Clinic in Arizona. "These decisions also present potential to raise patient and HCP awareness about treatment options that are available. Additionally, the issuance of these billing codes for these procedures is a first step in creating a consistent payment process for the procedure and an accountability of physicians for high quality procedures."
"Olympus is a pioneer of endoscopic endoluminal procedures. Starting with our work with physicians in Japan more than 20 years ago to develop endoscopic knives that allowed the introduction of ESD, we have been committed to expanding access to this minimally invasive procedure," said Kurt Heine, Group Vice President of the Endoscopy Division at Olympus Corp. "Through our partnership with GI societies, we have advocated for positive changes while striving to offer best-in-class education and a broad portfolio of devices to meet every procedural application."
Visit the Olympus product page to learn more about the complete line of gastroenterology devices.
Olympus is passionate about creating customer-driven solutions for the medical, life sciences, and industrial equipment industries.
In its Endoscopic Solutions business, Olympus uses innovative capabilities in medical technology, therapeutic intervention and precision manufacturing to help healthcare professionals deliver diagnostic, therapeutic and minimally invasive procedures to improve clinical outcomes, reduce overall costs and enhance the quality of life for patients and their safety. Starting with the world's first gastrocamera in 1950, Olympus' Endoscopic Solutions portfolio has grown to include endoscopes, laparoscopes, and video imaging systems, as well as system integration solutions and medical services. For more information, visit https://medical.olympusamerica.com.
Dr. Norio Fukami is a consultant to Olympus Corporation, its subsidiaries and/or its affiliates.
- CPT & Description: Copyright 2021 American Medical Association. All rights reserved. Applicable FARS/DFARS apply to government use
- Centers for Medicare and Medicaid Services, "October 2021 Update of the Hospital Outpatient Prospective Payment System" Sept. 16, 2021. https://www.cms.gov/files/document/R10997CP.pdf#page=21
- Draganov PV, Wang AY, Othman MO, Fukami N. "AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States." Clin Gastroenterol Hepatol. Jan. 17, 2019. (1):16-25.e1. doi: 10.1016/j.cgh.2018.07.041. Epub 2018 Aug 2. Accessed Oct 18, 2021