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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.

The cost of a reusable endoscopy ranges from $1,400 to $1,900 for each procedure, which does not include the cost for disinfection, repairs, and reprocessing. Reprocessing costs are particularly high, especially in the climate of COVID, in terms of double disinfection, labor, training, education, disinfection supplies, etc. In general, hospital-acquired infections arise in 1 to 1.2 percent of the procedures performed, which can be quite impactful to organizations financially and damage their overall reputation. Essentially, single-use endoscopes improve workflow and efficiency by streamlining operations.

With the onset of COVID, single-use endoscopies have played a significant role in improving efficiencies, and in some cases, saving money. Disinfecting reusable endoscopes can take up to two hours; however, achieving a guarantee of 100 percent clean is close to impossible. With the backlog of non-emergent care procedures, the risk of infection increases if the ability for disinfection is delayed.

Older technologies that require close contact with a patient, such as an ENT scope, place the doctor and patient in close proximity. Video technology allows an increased distance from clinician to patient. When non-emergent procedures came to a halt during COVID, reusable equipment began collecting dust while remaining on the balance sheet. Single-use endoscopes are considered supplies and do not depreciate, creating create predictable margins.

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.

The following CPT codes are reportable with HCPCS Code C1748, effective July 1, 2020 to June 30, 2023:

Programming Note: Listen to Susan Gatehouse report this story live today during Talk Ten Tuesdays, 10 Eastern.

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Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer

Susan Gatehouse is the founder and chief executive officer of Axea Solutions. An industry expert in revenue cycle management, Gatehouse established Axea Solutions in 1998, and currently partners with healthcare organizations across the nation, to craft solutions for unique challenges in the dynamic world of healthcare reimbursement and data management.

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