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

14 -Top Coding and Reimbursement Issues Impacting Physicians and Facilities_Mueller

Pdf Summary

In this presentation by Kathleen A Mueller, several coding and reimbursement issues impacting physicians and facilities are discussed. The first issue highlighted is billing for services not rendered or not provided as claimed, as well as submitting claims for equipment, medical supplies, and services that are not reasonable and necessary. Misuse of provider identification numbers is also a concern. Unbundling services and failure to properly use coding modifiers are mentioned as well.<br /><br />The presentation also focuses on specific issues related to gastroenterology (GI) practices, such as incident-to and split/shared billing, inappropriate modifier usage, and inadequate documentation. The importance of proper authentication of medical records is emphasized, as failure to authenticate a record in a timely manner may lead to recoupment of payments. <br /><br />The lack of specificity in diagnosis coding is discussed, with an emphasis on the importance of coding to the highest degree of specificity. The presentation also mentions the issues related to multiple endoscopy billing, including denials of biopsy when billed with snare removal. Hemorrhoid banding issues, such as the documentation of grade and symptoms, are addressed as well.<br /><br />Understanding the proper use of modifier 25 is highlighted, with attention to payer-specific guidelines. The presentation recommends using the XS modifier instead of the 59 modifier to bypass payer edits.<br /><br />Overall, the presentation provides insights into various coding and reimbursement issues faced by physicians and facilities, with a focus on GI practices. It offers suggestions and best practices for addressing these issues and ensuring compliance with coding and reimbursement guidelines.

Keywords

coding and reimbursement issues

physicians and facilities

billing for services

equipment and medical supplies

misuse of provider identification numbers

unbundling services

gastroenterology practices

incident-to and split/shared billing

authentication of medical records

diagnosis coding specificity