Publication of New Category I CPT Code is an Important Step in Establishing Access to Minimally Invasive Technology for Patients with Reflux
SAN MATEO, Calif.–EndoGastric Solutions (EGS), developer of an incisionless approach to treat Gastroesophageal Reflux Disease (GERD), announced today that the American Medical Association (AMA) has created a new Category I Current Procedural Terminology (CPT®) code with a procedure descriptor associated with the company’s Transoral Incisionless Fundoplication (TIF®) procedure for reflux.
The code, 432XX1, covers Esophagogastric Fundoplasty Trans-Orifice procedures, and will enable physicians to specifically communicate information to payers about the TIF procedure which is used to treat patients with chronic GERD.
The application for the new code was jointly sponsored by four key specialty medical societies: American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), American Society for Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES); this application was reviewed during the recent public CPT panel February meeting held in San Diego, California.
“AMA’s CPT Editorial Panel’s decision to add this Category I code in 2016 is significant as it enables healthcare providers better access to coding and payment structures in the U.S. than are currently available. This not only increases procedure choice for physicians but expands patient access for new technology for GERD patients,” said Philip Macdonald, Vice President, Healthcare Economics, Policy, and Reimbursement at EndoGastric Solutions.
The Summary of Panel Actions is a preliminary step; new and revised code descriptions may be further refined prior to implementation, scheduled for January 1, 2016.
“The AMA’s decision to create a unique CPT code that describes the transoral reconstruction of a defective gastroesophageal valve to prevent reflux is a significant milestone for GERD patients. It will allow well-selected GERD patients to receive an appropriate solution tailored to their disease stage,” said Skip Baldino, President and CEO of EndoGastric Solutions. “By creating this new code, the AMA has acknowledged the significant clinical evidence, including data from two randomized trials, and that this procedure has reached broad acceptance across both the GI and Surgeon physician community.”
“We are very pleased that the surgical and gastroenterological societies united in their support of the new code consistent with their continued efforts in advocating for evidence-based medicine and appropriate coding,” continued Baldino. “We feel that this is another important step in the process to provide broad availability to the innovative treatment option for millions of GERD patients.”
For additional information, please refer to the Summary of Panel Actions available on the AMA website.
About Current Procedural Terminology (CPT®)
CPT codes are a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services, and thereby serves as an effective means for reliable nationwide communication among physicians and other healthcare providers, patients, and third parties. CPT® is registered trademark of the American Medical Association [source].
Gastroesophageal Reflux Disease (GERD) is a chronic condition in which the gastroesophageal valve (GEV) allows gastric contents to wash back up into the esophagus, causing heartburn and possible injury to the esophageal lining. The stomach produces hydrochloric acid and other digestive enzymes after a meal to aid in the digestion of food. The cells that line the stomach are coated with a protective mucus that can withstand gastric contents, while the cells that line the esophagus lack the same protection.
GERD is the most common gastrointestinal-related diagnosis made by physicians during clinical visits in the U.S. It is estimated that pain and discomfort from acid reflux impacts over 23 million people two or more times per week in the U.S. The standard recommendations for symptomatic GERD patients include lifestyle changes (e.g. diet, scheduled eating times, and sleeping positions) and escalating doses of prescription medications for prolonged periods of time. Long-term, maximum dose usage of prescription medications has been linked to a variety of other health complications.
About the EsophyX® device
The EsophyX device was FDA cleared in 2007, and is commercially available in the United States. Inserted through the patient’s mouth with visual guidance from an endoscope, the EsophyX device is used to reconstruct the gastroesophageal valve (GEV) in order to restore its function as a barrier to prevent stomach acids from washing back up into the esophagus.
About Transoral Incisionless Fundoplication (TIF®) procedure for reflux
Performed entirely through the mouth without the need for external incisions through the skin, the TIF procedure offers patients who require an anatomical change to correct the underlying cause of GERD, another treatment option beyond traditional surgery. Studies show that for up to three years after the TIF procedure esophageal inflammation (esophagitis) is eliminated and most patients are able to stop using daily PPI medications to control symptoms.
The TIF procedure has an established safety and efficacy profile from more than 50 publications following over 800 unique TIF patients; now more than 16,000 TIF patients have been treated worldwide. For more information, visit www.GERDHelp.com.
About EndoGastric Solutions®
EndoGastric Solutions, Inc. (www.endogastricsolutions.com), is a leader in the endoluminal treatment of digestive diseases. EGS’ mission is to combine the most advanced concepts in gastroenterology and surgery to develop products and procedures that address unmet needs in gastrointestinal diseases.
EndoGastric Solutions, Inc.
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Phone: 646-871-8482 (direct)
The EsophyX device with SerosaFuse fasteners is indicated for use in transoral tissue approximation, full thickness plication and ligation in the GI tract and is indicated for the treatment of symptomatic chronic gastroesophageal reflux disease in patients who require and respond to pharmacological therapy. It is also indicated to narrow the gastroesophageal junction and reduce hiatal hernia <2 cm in size in patients with symptomatic chronic gastroesophageal reflux disease.