2015 Procedural Reimbursement Guide - Boston … PROCEDURAL REIMBURSEMENT GUIDE, FOR SELECT...

2015 Procedural Reimbursement Guide for Endoscopy

THIS PROCEDURAL REIMBURSEMENT GUIDE, FOR SELECT ENDOSCOPY PROCEDURES, provides coding and reimbursement information for physicians and facilities. The Medicare payment amounts shown are national average payments. Actual reimbursement will vary for each provider and institution based on geographic differences in costs, hospital teaching status, and proportion of low-income patients.

DESCRIPTION OF PAYMENT METHODS

PHYSICIAN BILLING AND PAYMENT: Medicare and most other insurers typically reimburse physicians based on fee schedules tied to CPT® CODES. CPT Codes are published by the American Medical Association and are used to report medical services and procedures performed by or under the direction of physicians.

HOSPITAL OUTPATIENT BILLING AND PAYMENT: Medicare reimburses hospitals for outpatient stays (typically stays of less than 24 hours) under AMBULATORY PAYMENT CLASSIFICATION GROUPS (APCs). Medicare assigns a procedure to an APC based on the billed CPT Code. Hospitals may receive separate APC payments for each procedure done during the same outpatient visit. Many APCs are subject to reduced payment when multiple procedures are performed on the same day. In most cases, the highest valued procedure is paid at 100% and all other procedures are subject to a 50% payment reduction.

HOSPITAL INPATIENT BILLING AND PAYMENT: Medicare reimburses hospital inpatient procedures based on the MEDICARE SEVERITY DIAGNOSIS RELATED GROUP (MS-DRG). The MS-DRG is a system of classifying patients based on their diagnoses and the procedures performed during their hospital stay. MS DRGs closely calibrate payment to the severity of a patient’s illness. One single MS-DRG payment is intended to cover all hospital costs associated with treating an individual during his or her hospital stay, with the exception of “professional” (e.g., physician charges associated with performing medical procedures). Private payers may also use MS-DRG based systems or other payer-specific system to pay hospitals for providing inpatient services. Effective October 1, 2013, Medicare implemented two-midnight stay guidance. Inpatient admittance is presumed to be appropriate if a physician expects a beneficiary’s surgical procedure, diagnostic test or other treatment to require a stay in the hospital lasting at least two midnights, and admits the beneficiary to the hospital based on that expectation. Documentation in the medical record must support a reasonable expectation of the need for the beneficiary to require a medically necessary stay lasting at least two midnights. If the inpatient admission lasts fewer than two midnights due to an unforeseen circumstance this also must be clearly documented in the medical record.

FREE-STANDING CLINIC/AMBULATORY SURGICAL CENTER BILLING AND PAYMENT: Many procedures are performed outside of the hospital in free-standing clinics. Payments made to free-standing clinics from private insurers depend on the contract the clinic has with the payer. Medicare payments to free-standing clinics are determined in part, by the licensing status of the clinic. If a free-standing clinic is licensed by Medicare as an AMBULATORY SURGICAL CENTER (ASC) it is eligible to be reimbursed for select procedures provided in this setting. Not all procedures that Medicare covers in the hospital setting are eligible for payment in ASCs. Medicare has approved over 3,000 procedures (as defined by CPT Code), for which it will pay the ASC a facility fee.

Effective: 1-JAN-2015

Expires: 31-DEC-2015

ENDO-47410-AF DEC2014 2

CPT copyright 2014 American Medical Association.

All rights reserved. CPT is a registered trademark of

the American Medical Association.

THIS GUIDE, FOR SELECT ENDOSCOPY PROCEDURES, PROVIDES CODING AND REIMBURSEMENT INFORMATION FOR PHYSICIANS AND FACILITIES.

THE CODES INCLUDED IN THIS GUIDE ARE INTENDED TO REPRESENT TYPICAL ENDOSCOPY PROCEDURES WHERE THERE IS:

1) At least one device approved or cleared by the U.S. Food and Drug Administration (FDA) for use in the listed procedure; and

2) Specific procedural coding guidance provided by a recognized coding or reimbursement authority such as the American Medical Association (AMA) or The Centers for Medicare and Medicaid Services (CMS). This guide is in no way intended to promote the off label use of medical devices.

THE MEDICARE REIMBURSEMENT AMOUNTS SHOWN ARE CURRENTLY PUBLISHED NATIONAL AVERAGE PAYMENTS.

Actual reimbursement will vary for each provider and institution for a variety of reasons including geographic difference in labor and non-labor costs, hospital teaching status, and/or proportion of low-income patients. On average, private payers pay significantly more than Medicare.8

Please feel free to contact the Boston Scientific reimbursement department if you have any questions.

Rates referenced in this guide do not reflect Sequestration; automatic reductions in federal spending that will result in a 2% across-the-board reduction to ALL Medicare rates as of January 1, 2015.

You can find reimbursement updates on our website: WWW.BOSTONSCIENTIFIC.COM/REIMBURSEMENT

Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifies for services that are rendered. Boston Scientific recommends that you consults with your payers, reimbursements specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label.

Effective: 1-JAN-2015

Expires: 31-DEC-2015

ENDO-47410-AF DEC2014 3

Medicare Physician, Hospital Outpatient, and ASC Payments

Hospital Inpatient Coding Hospital Inpatient Medicare Payment

CPT® Code1 Code Description Work Total Office Total

Facility In-Office In-Facility Hospital Outpatient ASC

Diagnostic

43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

5.95 9.82 9.82 $351 $351 $1,952 $1,071

Therapeutic

43261 Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple

6.25 10.28 10.28 $368 $368 $1,952 $1,071

43262 Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy

6.60 10.85 10.85 $388 $388 $1,952 $1,071

43263 Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi

6.60 10.88 10.88 $389 $389 $1,952 $1,071

43264 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s)

6.73 11.06 11.06 $395 $395 $1,952 $1,071

43265 Endoscopic retrograde cholangiopancreatography (ERCP); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy)

8.03 13.12 13.12 $469 $469 $1,952 $1,071

43277 Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct

7.00 11.48 11.48 $410 $410 $1,952 $1,071

43278 Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed

8.02 13.11 13.11 $469 $469 $1,952 $1,071

Stenting

43274 Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent

8.58 14.00 14.00 $501 $501 $3,174 $1,313

43275 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s)

6.96 11.42 11.42 $408 $408 $1,952 $1,071

43276 Endoscopic retrograde cholangiopancreatography (ERCP); with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged

8.94 14.57 14.57 $521 $521 $3,174 $1,313

Possible ICD-9-CM Procedure Codes

Code Description

51.10 Endoscopic retrograde cholangiopancreatography (ERCP)

51.11 Endoscopic retrograde cholangiography (ERC)

51.14 Other closed (endoscopic) biopsy of biliary duct or sphincter of Oddi

MS-DRG Description

Hospital Inpatient Medicare National Average Payment4

435 Malignancy of hepatobiliary system or pancreas with Major Complication or Comorbidity (MCC5)

$10,279

436 Malignancy of hepatobiliary system or pancreas with Complication or Comorbidity (CC5) $6,827

437 Malignancy of hepatobiliary system or pancreas without CC/MCC $5,262

438 Disorders of pancreas except malignancy with MCC5 $9,985

439 Disorders of pancreas except malignancy with CC5 $5,320

440 Disorders of pancreas except malignancy without CC/MCC $3,768

441 Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with MCC5 $11,048

442 Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with CC5 $5,435

443 Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis without CC/MCC $3,820

444 Disorders of the biliary tract with MCC5 $9,509

445 Disorders of the biliary tract with CC5 $6,249

446 Disorders of the biliary tract without CC/MCC $4,439

ENDO-47410-AF DEC2014Please refer to page 17 for footnotesSee important information about the uses and limitations of this document on pages 2 and 3 4

Biliary Procedural Reimbursement Guide - Select Endoscopy Procedures

RVUs Physician‡,2 Facility3

2015 Medicare National Average Payment




Cold Biopsy

43202 Esophagoscopy, flexible, transoral; with biopsy, single or multiple 1.82 10.40 3.23 $372 $115 $745 $409

43193 Esophagoscopy, rigid, transoral; with biopsy, single or multiple 2.79 4.93 4.93 $176 $176 $1,064 $584

43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple

2.49 11.48 4.29 $410 $153 $745 $409


6.25 10.28 10.28 $368 $368 $1,952 $1,071

44361 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple

2.87 4.91 4.91 $176 $176 $852 $467

44377 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy, single or multiple

5.52 9.13 9.13 $326 $326 $1,249 $685

44382 Ileoscopy, through stoma; with biopsy, single or multiple 1.27 2.33 2.33 $83 $83 $852 $467

44386 Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); with biopsy, single or multiple

2.12 10.10 3.66 $361 $131 $790 $433

44389 Colonoscopy through stoma; with biopsy, single or multiple 3.13 11.27 5.30 $403 $189 $790 $433

45305 Proctosigmoidoscopy, rigid; with biopsy, single or multiple 1.25 5.58 2.29 $200 $82 $827 $454

45331 Sigmoidoscopy, flexible; with biopsy, single or multiple 1.15 4.64 2.16 $166 $77 $494 $271

45380 Colonoscopy, flexible; with biopsy, single or multiple 4.43 13.18 7.40 $471 $265 $790 $433

Hot Biopsy

43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

2.40 12.04 4.18 $430 $149 $1,914 $1,050

43250 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

3.07 13.13 5.22 $469 $187 $1,064 $584

44365 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

3.31 5.46 5.46 $195 $195 $1,249 $685

44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

3.81 12.52 6.28 $448 $225 $790 $433

45308 Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery

1.40 6.28 2.59 $225 $93 $827 $454

45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

1.79 8.46 3.17 $302 $113 $494 $271

45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

4.69 13.21 7.76 $472 $277 $790 $433

ENDO-47410-AF DEC2014Please refer to page 17 for footnotesSee important information about the uses and limitations of this document on pages 2 and 3

Hospital Inpatient Coding and Medicare PaymentInpatient payment information not shown because the biopsy procedure will rarely, if ever, be the primary reason for a hospital admission.

5

Biopsy Procedural Reimbursement Guide - Select Endoscopy Procedures




Hospital Inpatient Coding and Medicare Payment



Balloon

43195 Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter)

3.07 5.39 5.39 $193 $193 $1,064 $584

43214 Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)

3.50 5.86 5.86 $210 $210 $1,064 $584

43220 Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)

2.10 32.49 3.67 $1,162 $131 $1,064 $584

43233 Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)

4.17 6.91 6.91 $247 $247 $1,064 $584

43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)

2.77 31.03 4.75 $1,109 $170 $1,064 $584

44381 Ileoscopy, through stoma; with transendoscopic balloon dilation Facility Only for 2015

Reporting

Facility Only for 2015

Reporting


Reporting


Reporting


Reporting

$852 $467

45340 Sigmoidoscopy, flexible; with transendoscopic balloon dilation 1.89 13.86 3.33 $496 $119 $827 $45445386 Colonoscopy, flexible; with transendoscopic balloon dilation 4.57 18.96 7.60 $678 $272 $790 $43344405 Colonoscopy through stoma; with transendoscopic balloon dilation Facility Only

for 2015 Reporting


Reporting


Reporting


Reporting


Reporting

$790 $433

Balloon or Rigid

43196 Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire

3.31 5.71 5.71 $204 $204 $1,064 $584

43213 Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed)

4.73 35.34 7.85 $1,264 $281 $1,064 $584

43226 Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire

2.34 10.91 4.04 $390 $144 $1,064 $584

43245 Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie)

3.18 17.69 5.39 $633 $193 $1,064 $584

43248 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire

3.01 11.83 5.14 $423 $184 $745 $409

45303 Proctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire, bougie) 1.50 27.58 2.69 $986 $96 $827 $454


Inpatient payment information not shown because the dilation procedure will rarely, if ever, be the primary reason for a hospital admission.

6

Dilation Procedural Reimbursement Guide - Select Endoscopy Procedures






Gastrostomy Tube Initial Placement

43246 Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube

3.66 6.11 6.11 $218 $218 $1,064 $584

49440 Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

4.18 29.60 6.48 $1,058 $232 $1,064 $584

Gastrostomy Tube Replacement/Reposition

43760 Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance

0.90 13.98 1.38 $500 $49 $195 $107

49450 Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

1.36 18.97 1.96 $678 $70 $488 $268

43761 Repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition

2.01 3.36 2.99 $120 $107 $745 $409

Jejunostomy Tube

49452 Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

2.86 25.60 4.10 $915 $147 $488 $268

49446 Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

3.31 28.45 4.75 $1,017 $170 $1,064 $584

44373 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube

3.49 5.88 5.88 $210 $210 $1,249 $685

49440 Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

4.18 29.60 6.48 $1,058 $232 $1,064 $584

Other Procedures

49460 Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed, image documentation and report

0.96 20.85 1.40 $745 $50 $488 $268


Hospital Inpatient Coding and Medicare PaymentInpatient payment information not shown because the enteral feeding procedure will rarely, if ever, be the primary reason for a hospital admission.

7

Enteral Feeding Procedural Reimbursement Guide Select Endoscopy Procedures





CPT® Code1 Code Description Work Total

OfficeTotal


Control of Bleeding

43227 Esophagoscopy, flexible, transoral; with control of bleeding, any method 2.99 11.33 5.09 $405 $182 $1,064 $584

43255 Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method

3.66 12.40 6.17 $443 $221 $1,064 $584

44366 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)6

4.40 7.36 7.36 $263 $263 $1,249 $685

44378 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)6

7.12 11.68 11.68 $418 $418 $1,249 $685

44391 Colonoscopy through stoma; with control of bleeding, any method 4.31 14.20 7.20 $508 $257 $790 $433

45334 Sigmoidoscopy, flexible; with control of bleeding, any method 2.73 4.68 4.68 $167 $167 $827 $454

45382 Colonoscopy, flexible; with control of bleeding, any method 5.68 17.12 9.39 $612 $336 $790 $433

Ligation

43205 Esophagoscopy, flexible, transoral; with band ligation of esophageal varices 2.54 4.35 4.35 $156 $156 $1,064 $584

43244 Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices

4.50 7.52 7.52 $269 $269 $1,064 $584

46221 Hemorrhoidectomy, internal, by rubber band ligation(s) 2.36 7.73 5.53 $276 $198 $442 $179

45350 Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) Facility Only for 2015

Reporting


Reporting


Reporting


Reporting


Reporting

$827 $454

45398 Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) Facility Only for 2015

Reporting


Reporting


Reporting


Reporting


Reporting

$790 $433

Injection

43201 Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance

1.82 7.92 3.22 $283 $115 $1,064 $584

43192 Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance

2.79 4.94 4.94 $177 $177 $1,064 $584

43204 Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices

2.43 4.22 4.22 $151 $151 $745 $409

43236 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance

2.49 11.20 4.30 $400 $154 $745 $409

43243 Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices

4.37 7.25 7.25 $259 $259 $745 $409

45335 Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance 1.46 7.83 2.65 $280 $95 $494 $271

44404 Colonoscopy through stoma; with directed submucosal injection(s), any substance


Reporting


Reporting


Reporting


Reporting


Reporting

$790 $433

45381 Colonoscopy, flexible; with directed submucosal injection(s), any substance 4.19 13.24 7.01 $473 $251 $790 $433

MS-DRG Description


377 GI Hemorrhage with Major Complication or Comorbidity (MCC5) $10,426

378 GI Hemorrhage with Complication or Comorbidity (CC5) $5,878

379 GI Hemorrhage without CC/MCC $3,975

432 Cirrhosis & alcoholic hepatitis with MCC5 $9,801

433 Cirrhosis & alcoholic hepatitis with CC5 $5,381

434 Cirrhosis & alcoholic hepatitis without CC/MCC $3,654


Hemostasis Procedural Reimbursement Guide - Select Endoscopy Procedures







Hot Biopsy

43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

2.40 12.04 4.18 $430 $149 $1,914 $1,050

43250 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

3.07 13.13 5.22 $469 $187 $1,064 $584

44365 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

3.31 5.46 5.46 $195 $195 $1,249 $685

44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

3.81 12.52 6.28 $448 $225 $790 $433

45308 Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery

1.40 6.28 2.59 $225 $93 $827 $454

45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

1.79 8.46 3.17 $302 $113 $494 $271

45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

4.69 13.21 7.76 $472 $277 $790 $433

Snare

43217 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

2.90 12.83 4.94 $459 $177 $1,064 $584

43251 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

3.57 14.42 6.02 $516 $215 $1,064 $584

44364 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

3.73 6.27 6.27 $224 $224 $1,249 $685

44394 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

4.42 14.15 7.35 $506 $263 $790 $433

45309 Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique

1.50 6.32 2.61 $226 $93 $827 $454

45338 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

2.34 9.08 4.04 $325 $144 $827 $454

45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

5.30 14.88 8.78 $532 $314 $790 $433

Hot Biopsy or Snare

45315 Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique

1.80 7.10 3.25 $254 $116 $827 $454

Other

43229 Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

3.59 20.88 6.06 $747 $217 $1,914 $1,050

Foreign Body Removal

43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s) 2.54 11.73 4.36 $419 $156 $1,064 $584

43247 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)

3.21 11.71 5.45 $419 $195 $745 $409

44363 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body(s)

3.49 5.88 5.88 $210 $210 $852 $467

45307 Proctosigmoidoscopy, rigid; with removal of foreign body 1.70 6.39 2.97 $228 $106 $1,657 $909

45332 Sigmoidoscopy, flexible; with removal of foreign body(s) 1.79 8.32 3.18 $297 $114 $827 $454

45379 Colonoscopy, flexible; with removal of foreign body(s) 4.68 14.25 7.78 $510 $278 $790 $433

43194 Esophagoscopy, rigid, transoral; with removal of foreign body(s) 3.51 5.56 5.56 $199 $199 $1,064 $584

Endoscopic Mucosal Resection

43211 Esophagoscopy, flexible, transoral; with endoscopic mucosal resection 4.30 7.27 7.27 $260 $260 $1,064 $584

43254 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection

4.97 8.25 8.25 $295 $295 $1,064 $584

44403 Colonoscopy through stoma; with endoscopic mucosal resection Facility Only for 2015

Reporting


Reporting


Reporting


Reporting


Reporting

$790 $433

45349 Sigmoidoscopy, flexible; with endoscopic mucosal resection Facility Only for 2015

Reporting


Reporting


Reporting


Reporting


Reporting

$827 $454

45390 Colonoscopy, flexible; with endoscopic mucosal resection Facility Only for 2015

Reporting


Reporting


Reporting


Reporting


Reporting

$790 $433


Inpatient payment information not shown because the polypectomy procedure will rarely, if ever, be the primary reason for a hospital admission.

9

Polypectomy Procedural Reimbursement Guide - Select Endoscopy Procedures






Biopsy

31625 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites

3.36 9.49 4.92 $339 $176 $1,055 $578

31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe

3.80 10.60 5.48 $379 $196 $1,055 $578

31632 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)*

1.03 2.03 1.41 $73 $50 $0 $0

Cytology and Brush

31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)

2.78 8.92 4.20 $319 $150 $1,055 $578

31623 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings

2.88 9.43 4.23 $337 $151 $1,055 $578

31624 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage

2.88 8.93 4.27 $319 $153 $1,055 $578

Foreign Body Removal (Stent Removal)

31635 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body

3.67 9.97 5.45 $356 $195 $1,055 $578

Needle Aspiration

31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)

4.09 16.78 5.91 $600 $211 $2,255 $1,237

31633 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure)*

1.32 2.51 1.83 $90 $65 $0 $0

31645 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial (eg, drainage of lung abscess)

3.16 9.22 4.66 $330 $167 $1,055 $578

Stenting

31631 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required)

4.36 6.70 6.70 $240 $240 $2,255 $1,237

31636 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus

4.30 6.41 6.41 $229 $229 $2,255 $1,237

31637 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; each additional major bronchus stented (List separately in addition to code for primary procedure)*

1.58 2.14 2.14 $77 $77 $0 $0

31638 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as required)

4.88 7.34 7.34 $262 $262 $2,255 $1,237

Balloon Dilation

31630 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fracture

3.81 5.79 5.79 $207 $207 $2,255 $1,237

Bronchial Thermoplasty

31660 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe

4.25 6.02 6.02 $215 $215 $2,255 N/A*

31661 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes

4.50 6.30 6.30 $225 $225 $2,255 N/A*


Pulmonary Procedural Reimbursement Guide - Select Endoscopy Procedures




Pulmonary Procedural Reimbursement Guide - Select Endoscopy Procedures

Hospital Inpatient Coding

Hospital Inpatient Medicare Payment

Possible ICD-9-CM Procedure Codes Code Description

32.01 Endoscopic excision or destruction of lesion or tissue of bronchus

32.27 Bronchoscopic bronchial thermoplasty, ablation of airway smooth muscle

33.23 Other bronchoscopy

33.24 Closed endoscopic biopsy of bronchus; bronchoscopy (fiber-optic) with brush biopsy of “lung”, brushing or washing for specimen collection, excision (bite) biopsy

33.27 Closed endoscopic biopsy of lung; Fiber-optic bronchoscopy with fluoroscopic guidance with biopsy, transbronchial lung biopsy

31.93 Replacement of laryngeal or tracheal stent

31.99 Other operations on trachea

98.15 Removal of intraluminal foreign body from trachea and bronchus without incision

33.91 Bronchial dilation

MS-DRG Description


180 Respiratory neoplasms with Major Complication or Comorbidity (MCC5) $9,895

181 Respiratory neoplasms pancreas with Complication or Comorbidity (CC5) $6,793

182 Respiratory neoplasms without CC/MCC $4,744

189 Pulmonary edema & respiratory failure $7,118

193 Simple pneumonia & pleurisy with MCC5 $8,500

194 Simple pneumonia & pleurisy with CC5 $5,683

195 Simple pneumonia & pleurisy without CC/MCC $4,132

196 Interstitial lung disease with MCC5 $9,757

197 Interstitial lung disease with CC5 $6,226

198 Interstitial lung disease without CC/MCC $4,724

204 Respiratory signs & symptoms $4,130

205 Other respiratory system diagnoses with MCC5 $8,211

206 Other respiratory system diagnoses without CC/MCC $4,658

163 Major Chest Procedures with MCC5,7 $29,522

164 Major Chest Procedures with CC5 $15,256

165 Major Chest Procedures without CC/MCC $10,687


CPT® Code1 G-Code Code Description Work Total Office Total


Biliary Stenting


8.58 14.00 14.00 $501 $501 $3,174 $1,313


6.96 11.42 11.42 $408 $408 $1,952 $1,071


8.94 14.57 14.57 $521 $521 $3,174 $1,313

Esophageal Stenting

43212 Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

3.50 5.79 5.79 $207 $207 $3,174 $1,313

43266 Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

4.17 6.92 6.92 $247 $247 $3,174 $1,313

Colonic and Duodenal Stenting

43266 Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

4.17 6.92 6.92 $247 $247 $3,174 $1,313

44370 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with transendoscopic stent placement (includes predilation)

4.79 8.14 8.14 $291 $291 $3,174 $1,313

44379 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with transendoscopic stent placement (includes predilation)

7.46 12.44 12.44 $445 $445 $3,174 $1,313

44384 Ileoscopy, through stoma; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)


Reporting


Reporting


Reporting


Reporting


Reporting

$852 $467

G6018 Ileoscopy,through stoma;with transendoscopic stent placement (includes predilation)

2.94 4.54 4.54 $162 $162 Physician Only for 2015

Reporting

Physician Only for 2015

Reporting

44402 Colonoscopy through stoma; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed)


Reporting


Reporting


Reporting


Reporting


Reporting

$790 $433

G6020 Colonoscopy through stoma;with transendoscopic stent placement (includes predilation)


Reporting


Reporting

45327 Proctosigmoidoscopy, rigid; with transendoscopic stent placement (includes predilation)

2.00 3.54 3.54 $127 $127 $3,174 $1,313

45347 Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)


Reporting


Reporting


Reporting


Reporting


Reporting

$827 $454

G6023 Sigmoidoscopy, flexible; with transenoscopic stent placement (includes predilation)


Reporting


Reporting

45389 Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)


Reporting


Reporting


Reporting


Reporting


Reporting

$790 $433

G6025 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)


Reporting


Reporting

Tracheobronchial Stenting

31631 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required)

4.36 6.70 6.70 $240 $240 $2,255 $1,237

31636 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus

4.30 6.41 6.41 $229 $229 $2,255 $1,237

31637 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; each additional major bronchus stented (List separately in addition to code for primary procedure)*

1.58 2.14 2.14 $77 $77 $0 $0


Stenting Procedural Reimbursement Guide - Select Endoscopy Procedures







42.81 Insertion of permanent tube into esophagus

46.86 Endoscopic insertion of colonic stent(s)

51.87 Endoscopic insertion of stent (tube) into bile duct

31.93 Replacement of laryngeal or tracheal stent

33.91 Bronchial dilation

98.15 Removal of intraluminal foreign body from trachea and bronchus without incision

MS-DRG Description


374 Digestive malignancy with Major Complication or Comorbidity (MCC5) $11,838

375 Digestive malignancy with Complication or Comorbidity (CC5) $7,290

376 Digestive malignancy without CC/MCC $5,291

388 GI obstruction with MCC5 $9,444

389 GI obstruction with CC5 $5,113

390 GI obstruction without CC/MCC $3,539

393 Other digestive system diagnoses with MCC5 $9,909

394 Other digestive system diagnoses with CC5 $5,542

395 Other digestive system diagnoses without CC/MCC $3,856

435 Malignancy of hepatobiliary system or pancreas with MCC5 $10,279

436 Malignancy of hepatobiliary system or pancreas with CC5 $6,827








13




Foreign Body Removal (Stent Removal)

43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s) 2.54 11.73 4.36 $419 $156 $1,064 $584

43194 Esophagoscopy, rigid, transoral; with removal of foreign body(s) 3.51 5.56 5.56 $199 $199 $1,064 $584

43247 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)

3.21 11.71 5.45 $419 $195 $745 $409


6.96 11.42 11.42 $408 $408 $1,952 $1,071

44363 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body(s)

3.49 5.88 5.88 $210 $210 $852 $467

45307 Proctosigmoidoscopy, rigid; with removal of foreign body 1.70 6.39 2.97 $228 $106 $1,657 $909

45332 Sigmoidoscopy, flexible; with removal of foreign body(s) 1.79 8.32 3.18 $297 $114 $827 $454

45379 Colonoscopy, flexible; with removal of foreign body(s) 4.68 14.25 7.78 $510 $278 $790 $433

Stenting Procedural Reimbursement Guide (Continued) Select Endoscopy Procedures







Cholangioscopy

43273 Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (List separately in addition to code(s) for primary procedure*

2.24 3.58 3.58 $128 $128 $0 $0




Diagnostic

43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

5.95 9.82 9.82 $351 $351 $1,952 $1,071

Therapeutic


6.25 10.28 10.28 $368 $368 $1,952 $1,071

43262 Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy

6.60 10.85 10.85 $388 $388 $1,952 $1,071

43263 Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi

6.60 10.88 10.88 $389 $389 $1,952 $1,071

43264 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s)

6.73 11.06 11.06 $395 $395 $1,952 $1,071

43265 Endoscopic retrograde cholangiopancreatography (ERCP); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy)

8.03 13.12 13.12 $469 $469 $1,952 $1,071

43277 Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct

7.00 11.48 11.48 $410 $410 $1,952 $1,071

43278 Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed

8.02 13.11 13.11 $469 $469 $1,952 $1,071

Stenting


8.58 14.00 14.00 $501 $501 $3,174 $1,313


6.96 11.42 11.42 $408 $408 $1,952 $1,071


8.94 14.57 14.57 $521 $521 $3,174 $1,313

CPT Code 43273 is an add-on code and must be reported with at least one of the following ERCP codes:

14

Cholangioscopy Procedural Reimbursement Guide Select Endoscopy Procedures

RVUs

RVUs

Physician‡,2

Physician‡,2

Facility3

Facility3







51.10 Endoscopic retrograde cholangiopancreatography (ERCP)

51.11 Endoscopic retrograde cholangiography (ERC)

51.14 Other closed (endoscopic) biopsy of biliary duct or sphincter of Oddi

MS-DRG Description


435 Malignancy of hepatobiliary system or pancreas with Major Complication or Comorbidity (MCC5)

$10,279

436 Malignancy of hepatobiliary system or pancreas with Complication or Comorbidity (CC5) $6,827


438 Disorders of the pancreas except malignancy with MCC5 $9,985

439 Disorders of the pancreas except malignancy with CC5 $5,320

440 Disorders of the pancreas except malignancy without CC/MCC $3,768







15

Cholangioscopy Procedural Reimbursement Guide Select Endoscopy Procedures




Upper Gastrointestinal Procedures

43232 Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)

3.69 13.76 6.05 $492 $216 $1,064 $584

43238 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures)

4.26 7.14 7.14 $255 $255 $1,064 $584

43242 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis)

4.83 8.05 8.05 $288 $288 $1,064 $584

Lower Gastrointestinal Procedures

45342 Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s)

4.05 6.77 6.77 $242 $242 $827 $454

45392 Colonoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures

6.54 10.73 10.73 $384 $384 $790 $433

44407 Colonoscopy through stoma; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures


Reporting


Reporting


Reporting


Reporting


Reporting

$790 $433


Hospital Inpatient Coding and Medicare PaymentInpatient payment information not shown because the transendoscopic ultrasound-guided fine needle aspiration procedure will rarely, if ever,

be the primary reason for a hospital admission.

16

Transendoscopic Ultrasound-Guided Fine Needle Aspiration Procedural Reimbursement Guide - Select Endoscopy Procedures



ENDO-47410-AF DEC2014See important information about the uses and limitations of this document on pages 2 and 3

‡ The 2015 National Average Medicare physician payment rates have been calculated using a 2015 conversion factor of $35.7547 which reflects changes for

January 1, 2015 through March 31, 2015. Rates subject to change.

N/A* Medicare has not developed a rate for the ASC setting as the procedure is typically performed in the hospital setting.

* Add-on codes are always listed in addition to the primary procedure code.

** WallFlex™, Percuflex™ C-Flex™ and Flexima™ Biliary RX Stent Systems as well as WALLSTENT™ Biliary Endoprostheses are not FDA-cleared for use in the

pancreatic ducts.

1 CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable

FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by

the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical

services. The AMA assumes no liability for data contained or not contained herein.

2 Center for Medicare and Medicaid Services. CMS Physician Fee Schedule - January 8, 2015 revised release, RVU15A file http://www.cms.gov/Medicare/

Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files-Items/RVU15A.html?DLPage=1&DLSort=0&DLSortDir=descending

3 Source: November 10, 2014 Federal Register CMS-1613-FC.

4 National average (wage index greater than one) DRG rates calculated using the national adjusted full update standardized labor, non-labor and capital

amounts ($5,865.48). Source: August 22, 2014 Federal Register.

5 The patient’s medical record must support the existence and treatment of the complication or comorbidity.

6 May include but is not limited to one of the following hemostasis techniques: injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma

coagulator.

7 Likely to pertain to bronchial thermoplasty only.

8 Based on estimate that non-Medicare payment for outpatient hospital services is 2.17 times Medicare payment. Source: High and Varying Prices for

Privately Insured Patients Underscore Hospital Market Power by Chapin White, Amelia M. Bond and James D. Reschovsky.

17

Footnotes

ENDO-47410-AF DEC2014

* Note: There is a separate facility and physician payment for outpatient hospital services. The values in this table refer to the outpatient hospital facility payment only.

APC Description 2015 Medicare National Average Payment3

0141 Level I Upper GI Procedures $745

0419 Level II Upper GI Procedures $1,064

0422 Level III Upper GI Procedures $1,914

0151 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) $1,952

0384 GI Procedures with Stents $3,174

0121 Level I Tube or Catheter Changes or Repositioning $488

0676 Thrombolysis and Other Device Revisions $195

0142 Level I Small Intestine Endoscopy $852

0424 Level II Small Intestine Endoscopy $1,249

0143 Lower GI Endoscopy $790

0146 Level I Sigmoidoscopy and Anoscopy $494

0147 Level II Sigmoidoscopy and Anoscopy $827

0428 Level III Sigmoidoscopy and Anoscopy $1,657

0148 Level I Anal/Rectal Procedures $442

0076 Level I Endoscopy Lower Airway $1,055

0415 Level II Endoscopy Lower Airway $2,255

See important information about the uses and limitations of this document on pages 2 and 3 18

Hospital Outpatient Facility PaymentTable 1. Final 2015 Hospital Outpatient Payments for Endoscopy Services*

ENDO-47410-AF DEC2014

1 For devices packaged in kits, hospitals may bill for the components of the kits that individually qualify for C-Codes. Facilities should bill for the estimated proportion of the kit that the C-Code eligible device comprises.

C-Code C-Code Description Devices Impacted1

C1726 Catheter, balloon dilation, non-vascular

CRE™ Single-Use Fixed Wire Esophageal Balloon Dilators

CRE Single-Use Pulmonary Balloon Dilators

CRE Single-Use Wireguided Esophageal/Pyloric/Biliary Balloon Dilators

CRE Single-Use Wireguided Esophageal/Pyloric/Colonic/Biliary Balloon Dilators

CRE Single-Use Wireguided Biliary Balloon Dilators

Hurricane™ RX Single-Use Biliary Dilatation Balloon Catheters

MaxForce™ Biliary Balloon Dilatation Catheters

MaxForce TTS™ Single-Use Balloon Dilators

Rigiflex™ II Single-Use Achalasia Balloon Dilators

C1769 Guide wire All BSC guide wires used in GI procedures: Dreamwire™ Guidewire, Hydra Jagwire™ Guidewire, Jagwire™ Guidewire, Pathfinder™ Guidewire

C1874 Stent, coated/covered, with delivery system

Polyflex™ Single-Use Esophageal Stent System

Polyflex Single-Use Self-Expanding Silicone Airway Stent System

Ultraflex™ Single-Use Covered Esophageal NG Stent System – Distal Release

Ultraflex Single-Use Covered Esophageal NG Stent System – Proximal Release

Ultraflex Single-Use Covered Large Esophageal NG Stent System – Distal Release

Ultraflex Single-Use Covered Large Esophageal NG Stent System – Proximal Release

Ultraflex Single-Use Covered Tracheobronchial Stent System - Distal Release

WallFlex™ Biliary RX Fully Covered Stent System

WallFlex Biliary RX Partially Covered Stent System

WallFlex Fully Covered Esophageal Stent

WallFlex Partially Covered Esophageal Stent System

WALLSTENT™ Endoscopic Biliary Endoprosthesis Stents

C1875 Stent, coated/covered without delivery system Dynamic™ (Y) Stent

C1876 Stent, non-coated/non-covered, with delivery system

Ultraflex Precision Single-Use Colonic Stent System

Ultraflex Single-Use Uncovered Esophageal NG Stent System – Distal Release

Ultraflex Single-Use Uncovered Esophageal NG Stent System – Proximal Release

Ultraflex Single-Use Uncovered Tracheobronchial Stent System – Distal Release

Ultraflex Single-Use Uncovered Tracheobronchial Stent System – Proximal Release

WallFlex Single-Use Colonic Stent System

WallFlex Single-Use Duodenal Stent System

WallFlex Biliary RX Uncovered Stent System

WALLSTENT RX Biliary Endoprosthesis Stent System

WALLSTENT Endoscopic Biliary Endoprosthesis Stents

WALLSTENT Single-Use Colonic and Duodenal Endoprosthesis with UniStep™ Plus Delivery System

C2617 Stent, non-coronary, temporary, without delivery system

Advanix™ Biliary Stent

Advanix Pancreatic Stent

C-Flex™ Double Pigtail Biliary Stent

Percuflex™ Duodenal Bend Biliary Stents

C2625Stent, non-coronary, temporary, with delivery system

Advanix Preloaded Biliary Stent Systems

Advanix Pancreatic Stent Kits

Flexima™ Biliary Stent Systems

Percuflex Duodenal Bend Biliary Stent with Introducer Kit1

RX Biliary Stents with RX Delivery System™

C1886 Catheter, extravascular tissue ablation, any modality (insertable) Alair™ Bronchial Thermoplasty Catheter

See important information about the uses and limitations of this document on pages 2 and 3 19

Endoscopy C-Code Summary

See important information about the uses and limitations of this document on pages 2 and 3

All trademarks are the property of their respective owners.

Boston Scientific Corporation300 Boston Scientific WayMarlboro, MA 01752www.bostonscientific.com/endo-resources

©2014 Boston Scientific Corporation or its affiliates. All rights reserved.

ENDO-47410-AF DEC2014Effective: 1JAN2015 Expires: 31DEC2015MS-DRG Rates Expire: 30SEP2015

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