43210: Relieve a Patients GERD, Collect $443

By Deborah Marsh

Technology updates are providing us with more and more minimally invasive versions of procedures, but
it can take time for them to prove their worth.
If your practice has been considering performing transoral fundoplication for patients with
gastroesophageal reflux disease (GERD), be sure to check out the technology coverage statement from
the American Gastroenterological Association (AGA).
Spoiler alert: The AGAs conclusion is that Transoral fundoplication should be covered and reimbursed
for appropriate patients who meet the selection criteria.
Here are some pointers on properly reporting this service.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Factor 43210 Into Your Reporting Plans

In 2016, CPT introduced 43210 (Esophagogastroduodenoscopy, flexible, transoral; with
esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed).
Procedure: You use this code for a transoral (through the mouth) approach to fundoplasty, a surgical
procedure in which the surgeon wraps the upper part of the stomach around the lower end of the
esophagus, suturing it in place. The goal is to strengthen and lengthen the lower esophageal sphincter to
reduce reflux. The surgery mechanically recreates the gastroesophageal valve, which means less
heartburn and regurgitation symptoms for patients.

Get Into the MPFS Details

Payment: Medicares national payment rate for 43210 in 2016 is $443.97.
Global: The Medicare Physician Fee Schedule (MPFS) shows 000 for the global days. A 0-day global
means: Endoscopic or minor procedure with related preoperative and postoperative relative values on
the day of the procedure only included in the fee schedule payment amount; evaluation and
management services on the day of the procedure generally not payable.
So related surgery-day E/M services are included in the global, but if the patient returns for a related
E/M a day or more after the surgery, that E/M is not included in the global period.
Comparison: Heres how 43210 stacks up against other CPT codes for fundoplication:

Open laparotomy, 43327, $852.86 MPFS national rate, 90 global days

Open thoracotomy, 43328, $1,182.62 MPFS national rate, 90 global days
Laparoscopic approach, 43280, $1,124.26 MPFS national rate, 90 global days.

What About You?

Have you seen a transition to minimally invasive procedures? How does your team prepare to report
new procedures?

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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Contact Us:
Name: Sam Nair
Title: Associate Director
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com