Iqbal S, Ali A, Razzaq A, Shahzad E. Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America. World J Gastrointest Endosc 2020; 12(1): 49-52 [PMID: 31942234 DOI: 10.4253/wjge.v12.i1.49]
Corresponding Author of This Article
Shahzad Iqbal, AGAF, FACG, FASGE, MD, Associate Professor, Department of Gastroenterology, Good Samaritan Hospital, 1111 Montauk Highway, Floor 3rd, West Islip, NY 11795, United States. siqbal50@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter To The Editor
Open-Access Policy of This Article
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. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jan 16, 2020; 12(1): 49-52 Published online Jan 16, 2020. doi: 10.4253/wjge.v12.i1.49
Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America
Shahzad Iqbal, Aman Ali, Arham Razzaq, Eman Shahzad
Shahzad Iqbal, Department of Gastroenterology, Good Samaritan Hospital, West Islip, NY 11795, United States
Aman Ali, Department of Gastroenterology, Lancaster General Hospital, Lancaster, PA 17602, United States
Arham Razzaq, Eman Shahzad, Herricks High School, New Hyde Park, NY 11040, United States
Author contributions: All authors equally contributed to the following criteria for authorship: drafting of the article, critical revision of the article for important intellectual content, and final approval of the article.
Conflict-of-interest statement: There are no conflicts of interest to declare in relation to this article.
Open-Access: 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. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shahzad Iqbal, AGAF, FACG, FASGE, MD, Associate Professor, Department of Gastroenterology, Good Samaritan Hospital, 1111 Montauk Highway, Floor 3rd, West Islip, NY 11795, United States. siqbal50@gmail.com
Received: May 8, 2019 Peer-review started: May 10, 2019 First decision: August 2, 2019 Revised: October 18, 2019 Accepted: November 4, 2019 Article in press: November 4, 2019 Published online: January 16, 2020 Processing time: 223 Days and 4.4 Hours
Abstract
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.
Core tip: Despite being minimally invasive and cost-effective alternates to surgery for removal of large gastrointestinal mucosal lesions, Endoscopic submucosal dissection has no approved or listed current procedural terminology for billing. It leads to much higher denial rate by the health insurance companies in North America. This scenario is highlighted in our article and is a hurdle in adoption of such useful techniques in private practice set-up.
