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Topics in Practice Management |

Airway Stenting*: Applications and Practice Management Considerations

Mark E. Lund, MD; Robert Garland, RRT; Armin Ernst, MD, FCCP
Author and Funding Information

*From the Interventional Pulmonology & Critical Care Medicine Department (Dr. Lund), St. Mary’s Regional Medical Center, Lewiston, ME; and Interventional Pulmonology (Mr. Garland and Dr. Ernst), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Correspondence to: Armin Ernst, MD, FCCP, Chief, Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Boston, MA 02215; e-mail: aernst@bidmc.harvard.edu



Chest. 2007;131(2):579-587. doi:10.1378/chest.06-0766
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Background: Airway stenting is a procedure that is performed increasingly often, and the availability of metallic stents placed by flexible bronchoscopy may have contributed to the increased usage. These procedures have an impact on the required physician skill set and practice management. We review the indications for airway stenting, and how the requirement of combined therapies and technical aspects of central airway stenting pertain to practice management.

Procedure: We compared several reimbursement scenarios for managing stent placement using the Centers for Medicare and Medicaid Services relative value units (RVUs) and average reimbursement amounts. We also compared the reimbursement to other commonly performed activities performed by pulmonary and critical care physicians. An analysis of Medicare facility outpatient and inpatient payment for procedures using silicone and metallic stents was also conducted.

Results: Professional reimbursement is identical regardless of stent type, method of insertion, and anesthesia administered. The net facility reimbursement largely depends on stent costs. The RVUs alone are a poor comparator for the reimbursement of therapeutic bronchoscopy because of Correct Coding Initiatives edits. Considering the time necessary for performing advanced therapeutic bronchoscopy, the professional fees are not attractive. The net facility reimbursement largely depends on stent costs.

Conclusion: The placement of airway stents is not reimbursed at competitive rates and may even lead to a net loss for the facility. The practice management benefits of central airway therapy are probably best obtained by a multidisciplinary airway team with an established cost center structure.

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