October 19, 2021 08:00 AM Eastern Daylight Time
WESTPORT, Conn.–(BUSINESS WIRE)–Lumendi– Effective October 1, 2021, the Centers for Medicare & Medicaid Services (CMS) established C9779 as a new Healthcare Common Procedure Coding System (HCPCS) code to describe the endoscopic submucosal dissection (ESD) procedure,1 including endoscopy or colonoscopy and mucosal closure, when performed by hospital outpatient departments. The APC payment is only for lower gastrointestinal and complex procedures.
“This is an important milestone in the broader acceptance and treatment of endoluminal procedures in the lower GI for complex polyps. Lumendi has been at the forefront of widespread adoption of endoluminal procedures, where many US patients are currently overtreated, and, therefore, underserved”
ESD is an emerging endoscopic procedure that uses special tools to dissect and remove pre-cancerous and early-stage cancerous polyps from the colon as a single specimen (en bloc). Over the last five years, ESD has gained greater acceptance within the GI medical community, which considers it a curative procedure that avoids conventional surgery.
“This is an important milestone in the broader acceptance and treatment of endoluminal procedures in the lower GI for complex polyps. Lumendi has been at the forefront of widespread adoption of endoluminal procedures, where many US patients are currently overtreated, and, therefore, underserved,” said Dr. Peter Johann, CEO of Lumendi.
In 2017, Lumendi launched its DiLumen® Endoluminal Interventional Platform (EIP), which enables endoscopic treatment of colonic lesions such as polyps, a common condition that affects millions worldwide. These endoscopic procedures may replace open surgical or laparoscopic procedures for the same condition, reduce healthcare costs, and better serve patients. DiLumen has been proven effective in lower GI procedures and aids physicians performing EMR and ESD procedures for removal of complex polyps. It also benefits patients who have undergone difficult or incomplete screening colonoscopies, due to a challenging or tortuous colon.
In the United States alone, more than 20 million screening colonoscopies are performed annually. In an estimated 4 to 11 percent of cases, a large colorectal polyp (2cm or greater) is identified, many of which are benign and can be removed endoscopically. Despite this, a disproportionate number of these patients are referred for surgical hemicolectomy (the removal of a portion of the colon and subsequent reconnection) despite a pronounced likelihood of benign, or non-cancerous, polyps present. Experts estimate that 20,000-30,000 similar surgeries for benign polyps are performed annually in the US. The effect of this trend is that patients may be overtreated with a riskier procedure with far-longer hospitalizations and recoveries, compared to a typical single-day, colon-preserving, endoluminal procedure.
About Lumendi, LLC (Lumendi) Headquartered in Westport, Connecticut, Lumendi, LLC is a wholly owned subsidiary of Lumendi Ltd., a privately held innovative, medical device company based in Buckinghamshire, UK. Lumendi focuses on developing, marketing, and distributing surgical tools and devices that provide safe, cost-effective solutions for minimally invasive gastrointestinal interventions.
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* Disclaimer: Lumendi provides this billing guide for informational purposes only. This guide is not an affirmative instruction as to which codes and modifiers to use for a particular service, supply, procedure, or treatment, nor is it exhaustive. It is the provider’s/facility’s responsibility to determine and submit the appropriate codes and modifiers for any service, supply, procedure, or treatment rendered. Actual codes and/or modifiers used are at the sole discretion of the treating provider and/or facility. Contact your local payer for specific coding and coverage guidelines. Lumendi cannot guarantee medical benefit coverage or reimbursement with the codes listed in this guide. Information included in this material was obtained from third-party sources and is accurate as of the time of its publication but is subject to change without notice.
1 October 2021 Alpha-Numeric HCPCS File, CMS.gov, available at https://www.cms.gov/files/zip/october-2021-alpha-numeric-hcpcs-file.zip-0.
2 CPT only copyright 2020 American Medical Association. All rights reserved. Applicable FARS/HHSARS apply.
3 OPPS Addendum B Update, October 2021, CMS.gov, available at https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppsaddendum-and-addendum-b-updates/october-2021-0.
4 See October 2021 ASC Approved HCPCS Code and Payment Rates, CMS.gov, available at https://www.cms.gov/apps/ama/license.asp?file=/files/zip/oct-2021-asc-approved-hcpcs-payment-rates.zip.
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Donna K. Ramer
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