2022 Gastroenterology Reimbursement and Coding Update: Concrete Solutions to Strengthen Your Foundation in GI Coding and Billing | November 2021-05 - Proper Documentation For Advanced Endoscopy

05 - Proper Documentation For Advanced Endoscopy_Vaughn

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This document provides an overview of proper documentation for advanced endoscopic procedures and offers reimbursement tips for billing unlisted procedures. The webinar covers various procedures, including Endoscopic Ultrasound (EUS), Endoscopic Mucosal Resection (EMR), Endoscopic Submucosal Dissection, Pancreatic Necrosectomy, EUS with Fiducial Marker Placement, Endoscopic Gastrocutaneous Fistula Closure, EDGE (Endoscopic Ultrasound Directed Transgastric ERCP), Peroral Endoscopic Myotomy (POEM), Transoral Incisionless Fundoplication (TIF), Chromoendoscopy, and Optical Endomicroscopy. <br /><br />For billing EUS, the physician must document the examination of all three areas of the upper GI tract with the use of ultrasound. When performing EUS and a separate biopsy, the modifier 59 should be used on the biopsy to indicate separate lesions.<br /><br />EMR codes (45390 for colon, 43254 for EGD, 45349 for flexible sigmoidoscopy) include submucosal injection, snare, and banding or special device usage. Biopsies of the same lesion prior to removal are not separately billable. Payers may request records before payment for EMR procedures.<br /><br />Endoscopic Submucosal Dissection is an unlisted procedure that requires the appropriate unlisted procedure code (45399 for colon, 43499 for esophagus, 43999 for stomach) and has RVUs similar to comparable procedures.<br /><br />Procedures like Pancreatic Necrosectomy (unlisted pancreas procedure) and EDGE (unlisted ERCP in RYGB patients) should be reported with unlisted procedure codes (48999 for pancreas, 47999 for EDGE) and comparable RVUs.<br /><br />Peroral Endoscopic Myotomy (POEM) is used for achalasia treatment and should be billed with CPT 43497 effective from 2022.<br /><br />Transoral Incisionless Fundoplication (TIF) can be reported with CPT 43210, which includes esophagogastric fundoplasty.<br /><br />Chromoendoscopy and Optical Endomicroscopy are considered components of standard endoscopy and do not require separate billing codes.<br /><br />Billing unlisted procedures requires appropriate documentation and a procedure description on the claim form. A fee schedule should be created based on comparable procedures' RVUs/fees. Additionally, a cover letter highlighting the benefits of endoscopic procedures and a cost comparison analysis with invasive procedures can be useful.<br /><br />Overall, proper documentation and communication between coders and physicians are crucial for accurate billing of advanced endoscopic procedures.

Keywords

advanced endoscopic procedures

reimbursement tips

Endoscopic Ultrasound (EUS)

Endoscopic Mucosal Resection (EMR)

Endoscopic Submucosal Dissection

Pancreatic Necrosectomy

EUS with Fiducial Marker Placement

Peroral Endoscopic Myotomy (POEM)

Transoral Incisionless Fundoplication (TIF)

Chromoendoscopy