“The economies of a GI center are different, in that there typically is no cherry-picking of payor classes,” says John Poisson, executive vice president of Physicians Endoscopy. “Medicare is nearly always included as part of the patient mix, and unlike many multispecialty centers, GI centers tend to be in-network as opposed to out-of-network.”
Despite the difficult economics that GI centers face from declining reimbursements for G-codes for screening colonoscopies and other reimbursement challenges, there are legitimate coding opportunities many endoscopy centers are missing, says Barry Tanner, president and CEO of Physicians Endoscopy.
Specifically, Medicare and many third-party payors reimburse a secondary procedure at 50 percent, but oftentimes ASCs do not include the second code when they bill for the service.
“A physician could be doing a colonoscopy in one part of the colon, do a polypectomy, and then somewhere else in the colon do a biopsy,” Mr. Poisson explains. “Those are two separate billable events; the center typically is paid 100 percent for the first one and 50 percent for the second one.”
For Medicare patients a third procedure would also be billed at 50 percent, Mr. Tanner says. Beyond three billable events, however, there typically is no further reimbursement. But in an area of medicine that has somewhat less control over billing than some other ASC specialties, ASCs that perform GI procedures should make sure they are not leaving any legitimate sources of revenue behind. “The challenge, or I guess the opportunity some centers aren’t capturing now, is billing for these secondary codes,” says Mr. Tanner.
Learn more about Physicians Endoscopy.
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