2023 Gastroenterology Reimbursement and Coding Update (On-Demand) | November 2022-Top 10 2022 Coding Questions Received by ASGE

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The following is a summary of the top 10 coding questions received by ASGE in 2022:<br /><br />1. Place of service for manometry and pH studies: The professional component should be billed with the place of service 22 for the outpatient location where the test was performed.<br /><br />2. Coding for colonoscopies and EGDs for Lynch Syndrome: For colonoscopies, use G0105 or 45378-33 with a diagnosis of personal or family history. For EGDs, since there are no screening EGDs, it's recommended to get an ABN/waiver signed.<br /><br />3. Billing modifiers 53 and 74: Medicare contractor Noridian addresses both modifiers. Modifier 53 should be used for the facility for discontinued procedures, and modifier 74 should be used after the start of anesthesia. Polyp rechecks should use the current polyp diagnosis if it was completely eradicated.<br /><br />4. Denial for inconsistent diagnosis: Billing D12.2 and K63.5 together is an Excludes-1 edit. If both an adenoma and hyperplastic polyp were removed, bill the most significant diagnosis of D12.2.<br /><br />5. Denials for mismatched authorizations: It's recommended to preauthorize all procedures that could be done during an endoscopic procedure, as some insurance companies like UHC and Cigna have been denying claims if the authorized procedure doesn't match the one performed.<br /><br />6. Coding for abnormal liver function: Specify the specific enzymes elevated for more accurate diagnosis coding. If not specified, R74.9 is appropriate.<br /><br />7. EGD referrals prior to weight loss surgery: Most commercial payers do not cover EGDs for asymptomatic individuals prior to weight loss surgery. ABN/waivers should be used in these cases.<br /><br />8. Documentation needed for billing EMR: The physician's documentation should include the term "EMR" to support billing code 45390 for endoscopic mucosal resection.<br /><br />9. Unlisted code denial: When using an unlisted code, fill in Box 19 with a description of the procedure. If it's left blank, Medicare will deny it as unprocessable. Appeal rights are not granted in this case.<br /><br />10. Coding for colonoscopies: Most payers accept G codes (G0121 or G0105) for colonoscopies, except Medicaid and some regional payers. It is recommended to use G codes for all payers who accept them for proper processing and preventive benefits if applicable.

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Kathleen A. Mueller, RN, CPC, CGCS, CCS-P, CMSCS, PCS, CCC

Keywords

Place of service

coding

colonoscopies

EGDs

Lynch Syndrome

billing modifiers

denial

inconsistent diagnosis

mismatched authorizations

EMR