43210: Relieve a Patient’s GERD, Collect $443

Fri, Jul 8, 2016 --

CPT Codes

GERD 43210

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 AGA’s 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.


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: Medicare’s 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: Here’s 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?


SuperCoder Spotlight: Get Specialty-Specific With Gastroenterology Coder

Slogging through updates to find the ones specific to your specialty can be tough. Let Gastroenterology Coder do the work for you! You can search for codes and Gastroenterology Coding Alert articles from The Coding Institute at the same time. Plus get compliance tools like a CCI edits checker, crosswalks, and fee schedules.


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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