CODING INFORMATION
EFFECTIVE 1/1/2019
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DESCRIPTION: The TIF procedure is an innovative and effective treatment for gastroesophageal reflux disease (GERD). Developed by EndoGastric Solutions® Inc., transoral fundoplication is performed from inside the patient’s stomach without incisions. This procedure delivers patient outcomes similar to those provided by conventional antireflux surgical procedures, but is less invasive, has fewer adverse effects, and does not limit future treatment options. Transoral fundoplication is able to repair the antireflux barrier, including reduction of hiatal hernia (≤ 2 cm), restoration of the angle of His, and re-creation of an antireflux valve with a minimum of 2cm in length and at least 270◦ in circumference similar to Toupet, Hill, and Belsey fundoplication procedures.
In a TIF 2.0 procedure, the patient is placed under general anesthesia so that the EsophyX® device, combined with a flexible endoscope for visualization, can be gently introduced into the stomach. The endoscope is retroflexed and the helical retractor is engaged into the tissue slightly distal to the Z line. Then, the fundus of the stomach is retracted and plicated around the distal esophagus utilizing the tissue mold and chassis of the device. After locking all the tissue handling elements, suction is applied via the device to position the GEJ under the diaphragm, and permits the reduction of hiatal hernia 2cm or smaller (if present). The fastener implants are then delivered through two layers of folded tissue as an anchor. The same maneuvers are repeated at 3 additional positions to create full thickness esophagogastric, partial wrap fundoplication; valves are anchored with at least 20 SerosaFuse® fasteners.
COMMONLY USED CODES
| ICD-10-CM Diagnosis | |
|---|---|
| K21.0 | Gastro-esophageal reflux disease with esophagitis |
| K21.9 | Gastro-esophageal reflux disease without esophagitis |
| K30 | Functional dysphasia |
| R10.13 | Dyspepsia NOS |
| K44 | Diaphragmatic hernia without obstruction or gangrene |
| R12 | Heartburn |
| Note: Underlying condition(s) should also be coded. Consult an ICD-10-CM manual for a complete list of diagnosis codes. | |
| ICD-10-PCS Procedure Codes | |
| 0DV48DZ | Restriction of Esophagogastric Junction with Intraluminal Device, Via Natural or Artificial Opening Endoscopic |
| Note: ICD-10-PCS procedure codes are used specifically by hospitals to describe services and procedures provided during an in-patient confinement | |
| DRG | |
| MS-DRG 326 | Stomach, Esophageal and Duodenal Procedures with MCC |
| MS-DRG 327 | Stomach, Esophageal and Duodenal Procedures with CC |
| MS-DRG 328 | Stomach, Esophageal and Duodenal Procedures w/o CC/MCC |
| Physician | |
| CPT® Code 43210 | Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed. |
| Outpatient Hospital Commercial | |
| CPT® Code 43210 | Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed. |
| Outpatient Hospital Medicare | |
| CPT® Code 43210 | EGD, flexible, transoral; w/ esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed. Ambulatory Payment Category (APC) 5362: Level 2 Laparoscopy and Related Procedures |
| Revenue Code | |
| 0278 | Other Implants |
DISCLAIMER: Health economic and reimbursement information provided by EndoGastric Solutions, Inc. is gathered from third-party sources and is subject to change without notice. The information contained in this reference is presented for information purposes only and does not constitute reimbursement or legal advice. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes and charges for services that are rendered. EGS recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coverage, coding and payment matters. CPT five-digit codes, descriptions, two-digit modifiers and other data are copyright ©2019 American Medical Association. All rights reserved. The codes referenced here are not all-inclusive and are not intended to represent all coding options.