2024 Gastroenterology Reimbursement and Coding Update | November 2023-16 - Top 10 2023 Coding Questions Received by ASGE

16 - Top 10 2023 Coding Questions Received by ASGE_Mueller

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The document presents the top 10 coding questions received by the American Society for Gastrointestinal Endoscopy (ASGE). The questions cover various topics related to medical coding for gastrointestinal procedures. Here is a summary of each question and its corresponding answer:<br /><br />Question #1: Can the physician bill for an EMR (endoscopic mucosal resection) if other techniques are used to complete the procedure? Answer: In most cases, only the EMR can be billed, but in rare circumstances, a modifier can be used to indicate the increased complexity of the procedure.<br /><br />Question #2: How should positive Cologuard tests be coded? Answer: If a positive Cologuard test leads to a follow-up colonoscopy, both procedures can be billed under the preventative benefit package.<br /><br />Question #3: Can two providers bill separately for an EGD/PEG tube change procedure? Answer: If two providers from separate specialties work together, the endoscopic PEG placement can be billed with a cosurgery modifier.<br /><br />Question #4: How should a colonoscopy with a polyp removed but not retrieved be coded? Answer: The procedure code for the snare technique should be used, and a modifier should be assigned to indicate that there is no confirmed pathology.<br /><br />Question #5: Why are there denials from United Healthcare & Cigna when the authorized procedure does not match the one performed? Answer: It is recommended to preauthorize all possible procedures during an endoscopic procedure to avoid denials.<br /><br />Question #6: What diagnosis code should be used for abnormal liver function blood tests? Answer: The specific enzymes elevated should be specified in the diagnosis code.<br /><br />Question #7: Why has there been a request for recoupment for infusion billing? Answer: The billing may not have met "incident to" requirements or the referring provider may not have been within the practice.<br /><br />Question #8: What documentation is needed to bill an EMR? Answer: The surgeon's documentation should specify the EMR technique used, and additional details may be required by payers before payment is made.<br /><br />Question #9: How should an unlisted code for a fistula closure be billed to Medicare? Answer: The unlisted code should be accompanied by proper documentation in Box 19 to avoid being deemed unprocessable by Medicare.<br /><br />Question #10: Can imaging interpretation during an ERCP be billed separately? Answer: If the provider personally interprets the images and provides detailed documentation, it may be possible to bill for imaging interpretation with the appropriate modifier.<br /><br />Overall, the document highlights common coding questions and provides answers to help clarify billing practices for gastrointestinal procedures.

Keywords

coding questions

gastrointestinal procedures

EMR

Cologuard tests

colonoscopy

EGD/PEG tube change

snare technique

denials

abnormal liver function

Medicare billing