2022 Gastroenterology Reimbursement and Coding Update: Concrete Solutions to Strengthen Your Foundation in GI Coding and Billing | November 2021-14 -Top Coding and Reimbursement Issues Impacting Physicians and Facilities

14 -Top Coding and Reimbursement Issues Impacting Physicians and Facilities_Mueller

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This document provides an overview of the top coding and reimbursement issues that are impacting physicians and facilities. The presentation is given by Kathleen A Mueller, who has a financial relationship with Boston Scientific. <br /><br />The first topic discussed is the Office of Inspector General (OIG) and Recovery Audit Contractor (RAC) issues. These include billing for services not rendered or provided, submitting claims for unnecessary equipment or services, misusing provider identification numbers, and unbundling services. The OIG's 2021 Work Plan also highlights telehealth services during the COVID-19 pandemic and the appropriate assignment of COVID-19 diagnoses.<br /><br />The next issue discussed is the authentication of the medical record and the importance of timely and proper authentication. Failure to authenticate the medical record can result in claims being considered invalid and subject to recoupment.<br /><br />ICD-10 specificity and substantiation of medical necessity is the third issue addressed. It emphasizes the importance of coding diagnoses to the highest degree of specificity, as it determines the medical necessity and level of service coded. Lack of specificity in diagnosis coding can result in claim denials or lower payment levels.<br /><br />Multiple endoscopy billing issues are also highlighted, including denial of certain procedures when billed together and the need for proper documentation to support separate procedures.<br /><br />Hemorrhoid banding issues are discussed, including the documentation requirements for grade of hemorrhoids, previous treatments, and risks associated with the procedure. Without proper documentation, there may be a lack of medical necessity for subsequent treatments.<br /><br />Finally, the presentation covers understanding modifier 25, which is used to indicate a significantly separate visit on the same day as a procedure. It advises on the appropriate use of modifier 25 and how it can vary depending on the payer.<br /><br />Overall, the presentation provides important information on coding and reimbursement issues that physicians and facilities should be aware of to ensure proper billing and compliance.

Keywords

coding and reimbursement issues

physicians and facilities

Office of Inspector General

Recovery Audit Contractor

telehealth services

authentication of the medical record

ICD-10 specificity

claim denials

proper documentation

modifier 25