Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/636789
1 3 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 6 Also trumpeting the impending arrival of a new CPT code is the company behind the LINX reflux man- agement system, a laparoscopic procedure that treats GERD by implanting a small flexible band of interlinked magnetic titanium beads around the lower esophageal sphincter, thus allowing only one-way passage from the esophagus to the stom- ach. The mechanism lets the forces that are used to swallow break the magnetic bond, allowing food and liquid to pass. When the magnets pull back together, they create a barrier to reflux. Torax Medical, the company behind LINX, says the CPT code covering it won't be effective until Jan. 1, 2017, something that might raise flags, says Kathleen Mueller, RN, CPC, CCS-P, CMSCS, CGCS, CCC, a cod- ing and reimbursement expert from Lenzburg, Ill., and the president of Ask Mueller Consulting. "A lot of times they (the AMA) give preliminary codes, but that doesn't mean they'll still go into effect," she says. "Sometimes at the last minute they change their minds and say no. It's always a 'may' until it gets pub- lished." Final determinations on CPT codes are released in the fall. Nothing is certain, acknowledges Rich Pilon, Torax's vice-president of global healthcare policy and reimbursement. "There are 3 distinct processes: coding, payment and coverage," he says. "The fact that we have a Category 1 CPT code assigned to us is a major hurdle, but there are 2 that remain. The next thing is the (determination of) relative value units. And the last piece is the coverage piece." In other words, whether payers will be willing to cover the procedure. But Mr. Pilon hopes the company won't have to wait until next January. "If everything goes our way, we'll have some coverage policies prior to the CPT code taking effect," he says. That would require payers to agree to reimburse facilities under the current CPT Category III code, 0392T. (Category III codes are temporary codes for new and emerging technologies.) He says Torax is negotiating with private payers, trying to get a head start. But Category III codes always end in "T," as in "temporary," and, says Ms. Mueller: "Medicare won't pay anything with a T behind it. You would still have to bill as an unlisted procedure." And as far as commercial payers go, "some will accept it and some will not." — Jim Burger Magnetic Bead Procedure Awaits CPT Code LINX REFLUX MANAGEMENT • HEALING FORCE The LINX system uses a small band of interlinked magnet- ic beads that prevent passage from the stomach to the esophagus. Torax Medical