“A device that can elute steroids at the site where polyps begin to grow, which is typically in the ethmoid sinus, is really an ideal implant,” he said. “This is the kind of therapy that we have been looking for as a targeted treatment option.”
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March 2014The Challenge of Reimbursement
Although there has been a strong push to obtain a CPT code for reimbursement for the steroid-eluting implants, efforts have been unsuccessful so far. According to Dr. Smith, this challenge is creating a firestorm within the specialty, with some physicians believing a new code is warranted and others sure that the placement of the implant is already included in the code for sinus surgery itself.
One of the questions being asked is whether placement of the implant requires extra work that could warrant the need for additional cost. “The answer is absolutely, even if it is done in the operating room,” said Dr. Kennedy. “To put in one of these implants, you have to get meticulous hemostasis, and you have to position the implants exactly so they are placed against a mucosa so they will work.”
Saying that the push for reimbursement needs to come from rhinologists, Dr. Kennedy is confident that it will happen. “I have no doubt that some type of code is going to be given for these implants,” he said, adding that he hopes it happens soon.
According to Lisa Earnhardt, president and CEO of Intersect ENT, the company will continue to push for coding to make these implants more widely available. “Ensuring access to Propel for the ENT community and their patients is a top priority,” she said, adding that the company intends to bolster their case with additional data and will resubmit the application for a category I CPT code later this year.
Mary Beth Nierengarten is a freelance medical writer based in Minnesota.