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

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In this document, Kathleen A Mueller, President of AskMueller Consulting, answers various coding questions related to healthcare procedures. <br /><br />Question #1 asks about the correct place of service for manometry and pH studies. The interpretation should be billed under place of service 22 for outpatient hospital, where the test was originally performed.<br /><br />Question #2 seeks coding suggestions for colonoscopies and EGDs for Lynch Syndrome. For colonoscopies, it should be covered as G0105 or 45378-33 with a diagnosis of personal or family history. EGDs are non-covered, so an ABN/waiver should be signed.<br /><br />Question #3 concerns the use of modifiers 53 and 74. Noridian, the Medicare contractor, addresses both modifiers and allows their use. Modifier 53 should be used by the facility for discontinued procedures. For shorter recall procedures, the current polyp diagnosis should be used if the site is being checked.<br /><br />Question #4 reflects a denial from Wellcare insurance due to inconsistent diagnoses listed on the claim. D12.2 and K63.5 cannot be billed together. Diverticulosis and hemorrhoids are considered incidental findings unless treatment is initiated.<br /><br />Question #5 discusses denials from United Healthcare and Cigna when the authorization doesn't match the procedure. It is recommended to preauthorize all possible procedures during endoscopic procedures.<br /><br />Question #6 clarifies diagnosis codes for abnormal liver function tests. Specific enzymes elevated should be specified in the diagnosis codes.<br /><br />Question #7 deals with EGD referrals prior to weight loss surgery. Some payers do not deem these medically necessary. Patients should be informed, and an ABN/waiver should be used.<br /><br />Question #8 explains the differences between a lift and snare polypectomy and injection-assisted EMR. Proper documentation including the term EMR should be used for billing an EMR.<br /><br />Question #9 addresses an unlisted code denial from Medicare. The code should be filled in Box 19. A documentation appeal can be made through the Medicare Portal.<br /><br />Question #10 asks about the correct coding for average and high-risk screenings. G codes are generally accepted by most payers except Medicaid, and using them is recommended for preventive benefits if appropriate.

Asset Subtitle

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

Keywords

coding questions

healthcare procedures

place of service

manometry

pH studies

Lynch Syndrome

modifiers

denial

diverticulosis

EGD referrals