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

Video Transcription
Video Summary
The video discusses the top 10 coding questions received by the American Society for Gastrointestinal Endoscopy (ASGE). The questions cover various topics related to coding for medical procedures. Here is a summary of each question:<br /><br />1. The question asks about billing for the professional component of manometry and pH studies. It is determined that the professional component should be billed with the place of service where the test was originally performed.<br /><br />2. The question is about coding for colonoscopies and EGDs for Lynch syndrome. It is explained that the coding varies depending on payer policies and whether there is a personal or family history associated with Lynch syndrome.<br /><br />3. The question relates to billing for procedures performed in an ambulatory surgery center. The facility is unsure about using modifier 74 for extenuating circumstances. It is advised to use modifier 74 for discontinued procedures after the start of anesthesia.<br /><br />4. The question is about billing for a colonoscopy with a primary diagnosis that was denied due to inconsistency with the procedure. It is clarified that certain diagnosis codes, such as D12.2 and K63.5, cannot be billed together.<br /><br />5. The question concerns denials from UnitedHealthcare and Cigna due to mismatched authorization and procedures. It is recommended to preauthorize all potential procedures during endoscopic procedures to avoid denials.<br /><br />6. The question asks about the appropriate diagnosis code for an abnormal liver function test. It is explained that specific diagnosis codes exist for different liver enzymes and it is important for doctors to specify the exact elevation in their documentation.<br /><br />7. The question relates to referrals for EGDs prior to weight loss surgery. It is mentioned that many payers do not cover this procedure for asymptomatic patients and pre-authorization should be sought to inform patients about coverage.<br /><br />8. The question is about documentation requirements for endoscopic mucosal resection (EMR) procedures. It is advised to provide detailed descriptions of the procedure and use the term "endoscopic mucosal resection" in the documentation to support billing for EMR.<br /><br />9. The question is about billing for an unlisted code for fistula closure that was denied as unprocessable by Medicare. It is emphasized that box 19 must be filled in with a specific description of the procedure for unlisted codes to be processed correctly.<br /><br />10. The question discusses the use of G codes for screening colonoscopies and whether to use 45378 with appropriate screening diagnoses. It is recommended to use the G codes for preventive benefits and refer to payer guidelines for specific code requirements.<br /><br />The video credits Kristen and Eden for providing answers to the coding questions on the ASGE helpline.
Asset Subtitle
Kathleen A. Mueller, RN, CPC, CGCS, CCS-P, CMSCS, PCS, CCC
Keywords
coding questions
ASGE
medical procedures
billing
diagnosis codes