3 GI/endoscopy coding & billing tips

Here are three coding and billing tips for gastroenterology and endoscopy procedures.

1. Prepare for impending coding changes. Approximately 25 percent of the 2014 CPT code updates affected gastroenterology, due to the review of upper GI/endoscopy codes. In 2014 some of the biggest changes, according to a Becker's ASC Review report, included additions to cover esophagoscopy, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography and image-guided fluid collection drainage by catheter. The changes were reflected in the following codes:

•    Codes 43191-43918
•    Codes 43211-43214
•    Code 43229
•    Code 43233
•    Codes 43253-43254
•    Code 43266
•     Codes 43270
•    Codes 43274-43278
•    Codes 49405-49407

This year, lower GI/endoscopy codes, including colonoscopy, are up for review. A significant number of changes reflected in the 2015 CPT code set are expected to impact GI.

2. Avoid common mistakes. Here are four common GI/endoscopy coding and billing mistakes to understand and avoid, according to a recent Becker's ASC Review article.

•    Modifiers. One of the most common GI/endoscopy coding mistakes is caused by confusion between modifiers -51 and -59.
•    Upcoding. Upcoding can occur when a follow-up visit with an established patient is coded at a level corresponding with a new patient office visit.
•    Patient information collection. Failure to collect patient insurance information and verify benefits can lead to denied claims.
•     Documentation. Payers are demanding to see patient medical records and physicians may not be prepared. Clean, accurate documentation is essential for avoiding coding errors and denials.

3. Prepare for the ICD-10 transition. The ICD-10 transition has been delayed until Oct. 1, 2015, but GI field stakeholders must still prepare. Here are three considerations for gastroenterologists on the impending adoption of ICD-10, according to a Becker's ASC Review article.

•    Increased specificity. The largest difference between ICD-9 and ICD-10 is the sheer number of codes. The jump in the number of codes is designed to allow for greater specificity. For example, the ICD-9 code for Internal Hemorrhoids without Mention of Complication is 455.0, but in ICD-10 the codes to describe this condition will expand to include:
•    K64.0: 1st Degree Hemorrhoids
•    K64.1: 2nd Degree Hemorrhoids
•    K64.2: 3rd Degree Hemorrhoids
•    K64.3: 4th Degree Hemorrhoids
•    K64.4: Residual Hemorrhoidal Skin Tags
•    K64.5: Perianal Venous Thrombosis
•    K64.8: Other Hemorrhoids
•    K64.9: Unspecified Hemorrhoids

•    Budget considerations. Expenses to factor into ICD-10 preparation include new EHR and practice management software, software upgrades, staff training and physician training.

•     Physician preparation. Engage gastroenterologists in the preparation process. For example, work with physicians to identify the top ICD-9 codes and create a document of corresponding ICD-10 codes.

CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

More articles on coding and billing:
5 ASC coding & billing changes to anticipate in 2015
3 tips for orthopedics coding & billing
3 OB/GYN coding and billing tips

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