Health Information Management

Enteryx: what it is and how to code

APCs Insider, January 26, 2004

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Enteryx: what it is and how to code

QUESTION: Our facility has started a new procedure in the gastrointestinal laboratory where an esophagogastroduodenoscopy (EGD) is performed with an injection of Enteryx for patients who suffer from gastroesophageal reflux disease (GERD). How should we code this procedure?

ANSWER: The Enteryx procedure involves injecting a liquid polymer and a solvent into the wall of the lower esophagus, creating a permanently implanted device that assists in keeping stomach acid in the stomach and not letting it reflux into the esophagus. It does this by strengthening the muscle that separates the lower part of the esophagus from the stomach. Using an endoscope, a physician will inject a liquid polymer into the muscle of the lower esophageal sphincter (LES) using a needle catheter. After the injection, the polymer will solidify into a spongelike permanent implant. This implant may help improve the barrier between the stomach and esophagus, also called the gastro-esophageal junction, by supporting and improving the elasticity of the lower esophageal sphincter. This will reduce and sometimes prevent acid reflux into the esophagus.

For 2004, C9704 (Injection or insertion of inert substance for submucosal/intramuscular injection(s) into the upper gastrointestinal tract, under fluoroscopic guidance) is a new technology procedure under the hospital Outpatient Prospective Payment System (OPPS). This procedure involves a single endoscopy (43234 or 43235), fluoroscopy, and the use of the device. Under the hospital OPPS, the initial endoscopy is separately reportable; however, payment for C9704 includes the device and fluoroscopy. Therefore, hospitals are not to report C9704 with CPT code 76000 (fluoroscopy).

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