Transnasal Endoscopy using digital full screen, CCD and LED technology, combined with a disposable Endosheath (TNE/DE), represents the best and most effective method for esophageal examinations in the current medical environment.

TNE/DE is the only currently available technology that combines:

  1.  Image quality
  2.  Procedure-related cost containment
  3.  Patient and staff safety
  4.  Improved professional reimbursement outcomes
  5.  Control of patient related costs and expenditures
  6.  Diagnostic capability equal to current video-endoscopy
  7.  Improved manpower-related logistics

Over the past 20 years there has been a significant increase in esophageal cancer, in particular adenocarcinoma of the EG junction, driven largely by the continued dramatic increase in reflux-related disease including Barrett’s esophagus. This has heightened the demand for investigative endoscopy to provide early detection, diagnosis and prevention of esophageal cancer.

During this same period of time, there has been a concomitant decline in available manpower (namely the number of Physician-providers), combined with increased competition for skilled Endoscopists’ time due to the burden of screening colonoscopy.  In addition, we continue to experience an adversarial insurance environment with accelerated downward pressure on reimbursements, and the increased burden on the patient by factors such as rising premiums, co-pays, and lost productivity and income as the result of time lost due to having to undergo sedated procedures.

Consider all the following factors, which establish why TNE/DE is the best solution to “The Perfect Storm,”…and it is available today.

  •  TNE/DE offers the superior image quality of standard videoendoscopy, with the convenience to both the patient and Physician of the esophageal pillcam. The procedure may be performed by either the Physician or midlevel provider, or by a trained Speech Language Pathologist with a subsequent video review by the physician similar to Pillcam.
  • All reimbursement barriers have been eliminated, and a payment track record already exists.
  • Patient and staff exposure to potentially harmful chemical disinfectants is eliminated with the use of the disposable Endosheath. The costs of reprocessing are also eliminated.
  • Facility use is maximized, with increased numbers of procedures possible due to elimination of the need for endoscope reprocessing. Procedures can be scheduled 15 minutes apart.
  • Patient and patient family loss of income and productivity is eliminated by the 5-minute non-sedated procedure.
  • The entry-level costs are a fraction of the costs for both Pillcam and standard videoendoscopy, maximizing the bottom line and making this a practical addition to the office or endoscopy suite.
  • The sub-specialist, surgeon, primary care physician, midlevel provider or specially trained SLP may perform TNE/DE, thereby relieving the pressure on physician-based manpower challenged resources.
  • Training programs for all levels of providers have already been developed and time-tested.

2014 GI Endoscopy Guide Medicare Reimbursement

CPT Codes (National Medicare Average)


Esophagoscopy, flexible, transnasal; diagnostic, includes collection of specimen(s) by brushing or washing, when performed (separate procedure)

ASC Facility Fee    Hosp, Facility Fee       Hosp/ASC MD Reimb.        Office MD Reimb.

$370.38                       $670.47                            $82.75                       $187.71


Esophagoscopy, flexible, transnasal; with biopsy, single or multiple

ASC Facility Fee       Hosp. Facility Fee       Hosp/ASC MD Reimb.     Office MD Reimb.

$370.38                      $670.47                            $98.51                        $209.56


Cost of Equipment (Manufacturer: Vision Sciences Inc.)

001 03-7001 SURGICAL PLATFORM (7000 SERIES) EA 1 $43,749.00

Includes: TNE-5000 Esophagoscope, DPU-7000A Digital Processing Unit, V1 Leak Tester, V1 Installation Stand Floor Model, 1 Box each (03-5102) TV-1.5mm Endosheath Technology and (03-5101) TV-2.1mm Endosheath Technology, 1 Case each of EndoWipe Towelettes (07-1000) and EndoWipe Enzymatic Cleaning Sponges (07-1020).

TOTAL: $43,749.00


ROI ……Ambulatory Surgery Center


Per procedure cost …….Avg. $50.00 / sheath plus nasal prep.


ASC Facility Fee + MD Reimbursement = (43197) $453.13


= (43198) $468.89


Average Reimbursement / Procedure = $400.00


Procedures / Day                  Sheath Cost                          Revenue +             ROI


5                                             $250.00                             $2000.00             22 Days


10                                           $500.00                             $4000.00             12 Days


15                                           $750.00                             $6000.00              8 Days


20                                           $1000.00                           $8000.00             5.2 Days



Per Procedure Cost……Avg. $50.00 / sheath plus nasal prep.

Physician Reimbursement / Procedure = (43197) $187.71

= (43198) $208.56


Average Reimbursement per Procedure = $148.63


Procedures / Day                   Sheath Cost                        Revenue +             ROI


5                                           $250.00                            $743.15               59 Days


10                                         $500.00                            $1486.30             29 Days


15                                         $750.00                            $2229.45             19 Days


20                                         $1000.00                          $2972.26             15 Days



ROI…….Hospital Out Patient

Per Procedure Cost…….. Avg. $50.00 / sheath plus nasal prep.

Hosp. Facility Fee + MD Reimbursement = (43197) $753.22

= (43198) $768.98


Average Reimbursement / Procedure = $711.10


Procedures / Day                   Sheath Cost                  Revenue +                       ROI


5                                          $250.00                       $3555.50                      12 Days


10                                        $500.00                       $7111.00                       6 Days


15                                        $750.00                       $10,666.50                    4 Days


20                                        $1000.00                     $14,222.00                    3 Days


Submitted to American College of Gastroenterology

Rationale for revising the ACG Guideline for the Diagnosis and Treatment of Gastroesophageal Reflux Disease

In ‘Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease,’ by Philip O. Katz, MD, Lauren B. Gerson, MD, and Marcelo F. Vela, MD, published in American Journal of Gastroenterology, (2013), 108, 308-328 (published online February 19, 2013), the authors revise the treatment guidelines for GERD and provide the following summary: