Differences in coding systems and payment methodologies contribute to the complexity of facility payment (Table 4). Regardless of the differences in Table 4, the fact that the type of stent placed substantially affects the net reimbursement holds true for both outpatient and inpatient facility payment. In Table 5, we show the effect of stent selection on facility payment under the Medicare Hospital Outpatient Prospective Payment System (HOPPS). The average metallic stent costs $1,800, while silicone stents cost $250 to $600. Therefore, using rigid bronchoscopy to place a silicone stent in the bronchus (CPT code 31636) could increase the net reimbursement by $1,063.54. When placing a second stent in a separate central airway, a second CPT code (31637) is used. This addition can magnify the differential cost of the self-expanding metallic [...]
As outlined above, stenting is medically complex, and its practice implications are therefore complicated. The procedure may be performed in the following different places of service (POSs): with the patient either under moderate sedation in an endoscopy unit or operating room or under general anesthesia in the operating room; and with either flexible or rigid bronchoscopy. Airway stenting is generally part of a multimodal approach to treating airway disease, so managing thoracic malignancies and the financial impact of stenting alone need to be placed into this context.
The finances of stenting and interventional bronchoscopy differ greatly between a multidisciplinary disease management team and a physician in private practice. We will focus on the issues of reimbursement for practice-employed physicians. Facility reimbursement, which becomes more complicated as coding systems and payment [...]
In managing CAO, combined therapies are routinely required to obtain the best outcomes. For example, endobronchial disease is effectively controlled with Nd-YAG laser ablation, argon plasma coagulation, electrocautery, microdebridement, endobronchial injections/topical applications or coring out, among other technologies.
Balloon bronchoplasty or tracheoplasty to dilate the stenotic airway is usually required to prepare a trachea with high-grade stenosis for stenting or for assisting in stent opening after deployment. In emergencies, a rigid bronchoscope can be used to dilate the central airways the condition of which is improved with medications of Canadian Health&Care Mall. Balloon bronchoplasty decreases the shearing forces, and induces less mucosal and submucosal trauma, potentially decreasing the likelihood of granulation tissue formation and the occurrence of restenosis. Thus, it is obvious that airway stenting in a pulmonary practice requires [...]
The incidence of central airway obstruction (CAO) is unknown, but an estimated 30% of all lung cancer patients will experience endobronchial disease, which is a major source of CAO. Minimally invasive therapies can be crucial for patients with inoperable disease or limited pulmonary function. Numerous studies have reported that endobronchial therapies, including airway stenting, can palliate symptoms in 80 to 97% of patients with dyspnea, Advanced knowledge and skills are required to insert these stents, and the ability to perform emergency procedures and procedures that require general anesthesia are necessary.
The overall management of CAO has been reviewed. Here, we review the indications and procedures for inserting stents and illustrate the associated issues with reimbursement.Indications for Stenting
The primary indications for stenting are (1) clinically important extrinsic compression on the central [...]