2023 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2022-Questions and Answers

Video Transcription

Video Summary

In the video, the speakers address various questions related to medical billing and coding. They discuss the possibility of billing a same-day consult note with a procedure and explain that it can be done using modifier 25, but the documentation should reflect a significantly separate service. They also mention that if a patient has multiple visits in preparation for a screening colonoscopy but does not comply, a visit prior to screening colonoscopy code (S0285) may be used. Additionally, they discuss topics such as billing for endoscopic sleeve gastroplasty and endoscopic suturing, which would require using unlisted procedure codes and providing detailed explanations to the payer. The speakers also address the issue of billing for ERCP in the context of transferring a patient from an outside hospital, stating that a separately identifiable E&M service may not be billed if the patient is stable and the procedure is known in advance. Finally, they mention that Cigna may not allow personal history of polyps as a primary diagnosis code for screening colonoscopies, suggesting the use of Z09 plus Z86.010 (follow-up after completed treatment) instead.

Keywords

medical billing

coding

same-day consult note

modifier 25

screening colonoscopy

S0285