Pursuit of a New Code for the Endoscopic Treatment of Zenker’s Diverticulum
By Richard W. Waguespack, MD, and Tricia Bardon During the 2010 Annual Meeting & OTO EXPO, the CPT/RUC Committee voted to request a new CPT code to capture the work done in endoscopic Zenker’s diverticulum surgery. The Physician Policy Payment Work Group (3P) agreed to this position because there is no specific code to report the procedure when it is performed endoscopically. Also, 3P was concerned about the potential erroneous billing of the procedure with CPT code 43130 – Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach, which was created to report the procedure when performed openly. Currently, the appropriate code to report the procedure when performed endoscopically is 43499 – Unlisted procedure, esophagus. (For more coding guidance on this procedure, visit http://www.entnet.org/Practice/CPT4ENT-Zenkers.cfm.) 3P also feared that if some members were incorrectly reporting the procedure they may be exposed to denials and/or audits from payers. 3P determined that although some segments of the specialty (typically academically based subspecialists) were appropriately reimbursed for Zenker’s diverticulum when they reported the unlisted code (43499), much of the general membership experienced significant reimbursement challenges for the procedure. Members of 3P, the CPT & Relative Value Committee, and other interested parties deliberated on whether the Academy should request a new code for the endoscopic treatment of Zenker’s diverticulum in time to be published in the 2012 CPT book. (In order to be included, a new code must be accepted by March of the year prior to publication of the CPT coding book.) As a result of these discussions, 3P decided to disseminate a survey in January 2011 through The News, the Academy’s electronic newsletter. After analyzing the results of the survey, 3P determined it was in members’ best interests not to request a new code for the endoscopic procedure at that time. Subsequently, 3P made the decision to re-survey members to reach a larger audience to determine if the Academy should pursue a new code for the procedure. As such, we will repeat the January 2011 survey before the end of the year. Please take this survey when it is available and ensure your Academy fully captures your coding needs for endoscopic Zenker’s diverticulum. If the generated data from the survey leads us to request a new code for endoscopic Zenker’s diverticulum, this code would be available for billing in the 2013 CPT coding manual. For more information, contact Tricia Bardon at TBardon@entnet.org.
By Richard W. Waguespack, MD, and Tricia Bardon
Currently, the appropriate code to report the procedure when performed endoscopically is 43499 – Unlisted procedure, esophagus. (For more coding guidance on this procedure, visit http://www.entnet.org/Practice/CPT4ENT-Zenkers.cfm.) 3P also feared that if some members were incorrectly reporting the procedure they may be exposed to denials and/or audits from payers. 3P determined that although some segments of the specialty (typically academically based subspecialists) were appropriately reimbursed for Zenker’s diverticulum when they reported the unlisted code (43499), much of the general membership experienced significant reimbursement challenges for the procedure.
Members of 3P, the CPT & Relative Value Committee, and other interested parties deliberated on whether the Academy should request a new code for the endoscopic treatment of Zenker’s diverticulum in time to be published in the 2012 CPT book. (In order to be included, a new code must be accepted by March of the year prior to publication of the CPT coding book.) As a result of these discussions, 3P decided to disseminate a survey in January 2011 through The News, the Academy’s electronic newsletter.
After analyzing the results of the survey, 3P determined it was in members’ best interests not to request a new code for the endoscopic procedure at that time. Subsequently, 3P made the decision to re-survey members to reach a larger audience to determine if the Academy should pursue a new code for the procedure.
As such, we will repeat the January 2011 survey before the end of the year. Please take this survey when it is available and ensure your Academy fully captures your coding needs for endoscopic Zenker’s diverticulum. If the generated data from the survey leads us to request a new code for endoscopic Zenker’s diverticulum, this code would be available for billing in the 2013 CPT coding manual. For more information, contact Tricia Bardon at TBardon@entnet.org.