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Information for Those Who Live Far Away

by , last modified on 3/1/23

At this time, we are no longer accepting new patients who live outside of Northern Virginia until further notice.

Old Information Content: In the last 12 months, patients from Arizona, Florida, Pennsylvannia, California, Texas, and NY have come to have this procedure done by Dr. Chang. Though you don't have to live in another state, if you live at least >2 hours drive away and would like to travel to Warrenton, VA to have Dr. Chang treat your Zenker's Diverticulum using the mininimally invasive ESD procedure, here are the steps to take. These steps also prevent patients who are not surgical candidates from wasting their time traveling to see Dr. Chang. Please note that from first contact to having the surgery peformed may take a few weeks.

Also, you MUST have insurance coverage that we participate with (you have to call your insurance company and ask if Dr. Chang is in-network with your plan) in order to have this procedure done by Dr. Chang.

In event we do not participate with your health insurance plan, you can request a "Letter of Medical Necessity" from you primary care doctor for temporary non-par provider health insurance coverage (out-of-network coverage).


Contact your insurance company to make sure you are able to go out-of-network for your care (if you have Medicare as primary insurance, you are covered). This is YOUR responsibility. Not ours. Insurance we participate with can be found here. When you call your insurance to determine what out-of-pocket expenses there may be, they may ask for the following information:

  • Diagnosis Code: ICD-10: K22.5; ICD-9: 530.6
  • Procedure Codes: 43180

Email Dr. Chang with your interest.

Mail a CD to Dr. Chang's attention containing the actual images of the barium swallow showing the Zenker's Diverticulum. Make sure an official report is also contained. A CD can be created for you if you request it from the radiology department where you had the exam performed. A report by itself is NOT good enough. The images are required as well. (An EGD from a gastroenterologist is not helpful information when considering surgery.) Generally speaking, the diverticulum needs to be at least 1.5cm in size, otherwise, symptom relief is typically incomplete with a higher rate of recurrence.

Email/Mail to Dr. Chang the following digital pictures of your head, neck, and shoulders (there are regular photos taken with a regular camera... not x-rays):

  • Pic #1: Side Profile - Bend head forward as far as possible (chin to your chest).
  • Pic #2: Side Profile - Bend head as far back as possible (like looking up at the ceiling).
  • Pic #3: Mouth Open View - Mouth as wide open as possible (to make sure it is large enough to accomodate the instruments needed to perform procedure endoscopically)


Once Dr. Chang feels you have the appropriate physique and the Zenker's Diverticulum is amenable to ESD, he will contact you confirming candidacy. The next few steps should be than taken:


Fax (540-347-5224) your complete health insurance information to the office as soon as possible (front and back of all your health insurance cards).

• SCHEDULE an appointment to see Dr. Chang as well as the surgery. Ideally, the appointment should be on a Tuesday morning with surgery the next day on Wednesday.

• COMPLETE HISTORY AND PHYSICAL within 30 days of the tentative surgery day from your primary medical doctor for preoperative clearance faxed to our office as soon as possible. The sooner the better. Be sure that a list of all your medications is included.

Based on your past medical history, additional information as well as additional physician evaluations may be requested.

• OFF ALL BLOOD THINNERS (pradaxa, xarelto, plavix, coumadin, aspirin, ibuprofen & other NSAIDS, etc) for 7 days prior to and for 3 days after surgery. If you are on these medications, please have your physician state both pre and post-operative recommendations.

• FOLLOWING STUDIES WITHIN 30 days of the surgery date and reports faxed to our office: EKG, CBC, Chem7, PT, PTT, albumin, prealbumin, and chest X-ray (PA/lateral).

• DOWNLOAD, complete, and fax our office forms to us.

Once the office receives all this information, both Fauquier Hospital and our office will obtain preauthorization from your health insurance company. Depending on your health insurance company, your primary care doctor may need to write a letter of medical necessity as to why you are going out-of-network for your treatment. The following steps will occur as well.


If you aren't already, START taking prilosec (over-the-counter) or equivalent (ie, Nexium, protonix, aciphex, etc) one week before the procedure. If you are unable to swallow pills, have your local doctor prescribe Prevacid 15mg solutabs (take two tablets daily). Prevacid solutabs dissolve in the mouth. You will need to continue taking this medication for a total of 3 months. This medication has been found to significantly reduce the risk of the Zenker's Diverticulum recurring after the procedure.

Depending on how the operation goes, you may spend one night in the hospital or be discharged after a few hours.

Please note that Dr. Chang reserves the right to have you see any necessary physicians locally in Warrenton, VA (pulmonologist, cardiologist, internist, radiology, etc) before your surgery to make sure you are optimized medically (will occur same day as appointment or immediately before surgery).

It would be worthwhile to carefully read the informed consent for the ESD procedure which goes over risks and call Dr. Chang with any questions you may have.

Post-op instructions can be reviewed here.

Lastly, though you may have committed the time and expense to come to have the ESD procedure done, if there are any medical concerns that you may not tolerate the procedure or the general anesthesia to undergo the procedure, Dr. Chang reserves the right to delay or even cancel the surgery.


Once your surgery (if applicable) is scheduled, you can contact the hospital at 540-316-5014 to make hotel arrangements for you at a deeper discount than you may find on your own.

Hotels nearby where you can stay.

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