Mina Rismani, MD, Wesley Jones, MD, Veeral M. Oza, MD Prisma Health, Greenville, SC
Introduction: Duodenoscopes are complex instruments often used to perform Endoscopic retrograde cholangiopancreatography (ERCP). Unfortunately, these are associated with scope-associated infections and a rise in multi-drug resistant organisms. In 2019, the FDA approved the use of the first single-use duodenoscope (SUD). Two major SUD are currently available in the United States, Exalt-D by Boston Scientific and aScope Duodeno by Ambu. Studies show that the cost of the SUD maybe prohibitive to hospital systems, particularly if the reimbursement is low, despite usage of the new-technology add-on payment (NTAP). Although studies on cost-effectiveness of the SUD are previously published, there is no data available on the exact reimbursement by Medicare, Medicaid, and private insurance companies. We hypothesize that usage of the SUD does not result in any additional expense to the hospital system. In this retrospective analysis we investigate the reimbursement of cases at our institution in which a disposable duodenoscope (Exalt-D) was utilized.
Methods: We performed a retrospective database search from April 2022 to September 2022 on our EMR system (EPIC) of all the ERCPs where Exalt-D was utilized. The CPT code for ERCP, (43260-43265, 43274-43278) and the NTAP code, C1748, were utilized to perform the search. Reimbursement data for all ERCP procedures utilizing Exalt-D were retrieved.
Results: About 500 ERCPs were performed at our institution over the 6-month period. Of these, 33 cases involved usage of Exalt-D. Payers included Managed care, Medicare, and Medicaid. Due to proprietary regulations, only percentages of reimbursement are reported. The cost of the Exalt-D to our system was $2390. Positive reimbursement was noted in 32/33 cases; Managed care/Private payer reimbursement was +37%, and Medicare and Medicaid reimbursement was +17 and +16%, respectively. One case involved an uninsured patient, and reimbursement was not expected in that case
Discussion: This small retrospective analysis identifies Managed care, Medicare, and Medicaid reimbursement of Exalt-D-assisted ERCP at a single center. We suspect the positive procedural reimbursement noted at our institution can be extrapolated to other hospital systems. A more detailed analysis with specific numbers is needed, and recent legislation and laws may assist in being able to perform those specific analyses. This data reveals a high yield reimbursement of SUD in ERCP suggestive, that the use of this scope is not cost prohibitive to hospital systems.
Disclosures:
Mina Rismani indicated no relevant financial relationships.
Wesley Jones indicated no relevant financial relationships.
Veeral Oza: Boston Scientific – Consultant.
Mina Rismani, MD, Wesley Jones, MD, Veeral M. Oza, MD. P3709 - Usage of Single-Use Duodenoscope Is Not Cost Prohibitive: A Single-Center Experience, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
