By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer
An increase in hospital-acquired infections, supply chain challenges, cost containment, and a backlog of some endoscopic procedures have been catalysts for migrating from reusable to single-use endoscopies.
The global disposable endoscope market size is predicted to reach $2.7 billion by 2025 – an astoundingly large number! Though not all-inclusive, this disposable endoscopic market incorporates bronchoscopy, GI endoscopy, ENT endoscopy, urologic, and arthroscopy. An increase in hospital-acquired infections, supply chain challenges, cost containment, and the backlog of some endoscopic procedures have contributed to migrating from reusable to single-use endoscopies.
Effective July 1, 2020, HCPCS code C1748 for Endoscope, single-use (i.e., disposable), upper GI, imaging/illumination device (insertable) was approved as a transitional pass-through item through June 30, 2023. Transitional pass-through status is intended to encourage the use of newly FDA-approved medical devices, drugs, and biologics across all fields of medicine and to boost Medicare patients’ access to these innovative therapies by temporarily paying more than established facility fees. The Transitional Pass-Through (TPT) payment formula is derived from using the charge for the procedure performed multiplied by the cost-to-charge ratio. This allows payment for the TPT, as well as payment for the procedure performed.
For billing purposes, the CPT® procedure code is reported for the procedure performed. The transitional pass-through code is reported under sterile supplies (Revenue Code 272 or Revenue Code 278) for medical or surgical implants. Please note that not all third-party payors will reimburse for single-use endoscopes. It is advised to review third-party contract language to determine specific reimbursement coverage. It is anticipated that this market will only expand due to the momentum and interest generated by single-use endoscopies.
Axea's CEO, Susan Gatehouse expands on the topic in an article published by ICD10Monitor. You can read the entire article and access the related CPT codes at the ICD10Monitor website: Single-Use Endoscopies: An Alternative for Non-Emergent Procedures - ICD10monitor