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.
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5 ASC coding & billing changes to anticipate in 2015
3 tips for orthopedics coding & billing
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