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Is this stating that a family pr ...

Posted Nov 10 2008 4:21pm

Is this stating that a family practice physician is a "non expert" on the diagnosis and treatment of GERD?  Is there something missing the coding to make sure the physician gets reimbursed?  BD

Sixty million Americans suffer from gastroesophageal reflux. In the past, treatment consisted of medical therapy or a surgical fundoplication. The trend toward less invasive procedures has given rise to endoluminal therapies for reflux. These initial forays were significant for early failure or complications. [1] Insurance companies set up guidelines making reimbursements for any endoluminal therapy nearly impossible. Even reasonably safe and effective [2-5] FDA-approved therapies with level 1 CPT codes have been consistently denied.

Physicians attempting to secure reimbursement from different payors often heard denial policies read to them by staffers who referred them to nonexpert physicians who reread the policies and never revealed the names of those in the committee who formulated them. Medical directors reiterated early failures and offered a frustrating series of moving targets. The lesson to be learned from this was simple: "If you make it hard enough, the docs will just give up and go away."

Reimbursement for New Technologies: The GERD Maze Is Not Patient-Friendly

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