2025 Gastroenterology Reimbursement and Coding Update (On-demand)| November 2024-Bonus Material: Coding Q and A

Bonus Material: Coding Q and A

Pdf Summary

The 2025 Gastroenterology Reimbursement and Coding Update addressed various coding and billing queries. Key points included:<br /><br />1. **E&M Documentation**: The chief complaint can be documented in the assessment section or an addendum. Acute dysphagia consultation might be Level 4 or 5 based on risk factors. An attending cannot bill if they haven't interviewed or examined the patient before discharge. For telephone visits, calls are billable if patient-initiated and not within 72 hours of a follow-up.<br /><br />2. **Split-Shared Billing**: The attending must document and sign a split-shared bill to demonstrate substantial involvement. They need not have physically seen the patient.<br /><br />3. **Screening and Diagnostic Procedures**: For CRC screening with a positive stool test, average risk screening should use G0121 for Medicare, with specific ICD-10 codes. Removing polyps during screening uses CPT 45385 with a PT modifier for Medicare. Consistent procedural documentation is recommended.<br /><br />4. **Specific EUS Codes**: For EUS with liver biopsy, use 43238 or 43242 if the full GI tract was evaluated through EUS.<br /><br />5. **Modifiers and Procedures**: Modifier 22 isn’t for translator services under E&M. Modifier 53 for incomplete colonoscopies is subject to carrier policies. In specific scenarios, such as balloon dilation and biopsy, only certain actions are billable. Modifier 74 is applicable for ASCs and hospitals for supplies but stops time clocks for screening benefits.<br /><br />6. **Injections**: 43236 is for ink or Botox injections during EGD, and 45381 is for colonoscopy marking.<br /><br />7. **Unlisted Procedures**: Codes like 44360/44376 are for antegrade double-balloon enteroscopy, while 44799 is for retrograde evaluations. Endoscopic vacuum therapy uses unlisted code 43499, similar to surgical repair code 43405. Z-POEM for Zenker’s Diverticulum uses 43499, with a comparative code 43180.<br /><br />Further resources include the GI Coding Certification from AAPC, and additional inquiries can be directed to codingquestions@asge.org.

Keywords

Gastroenterology

Reimbursement

Coding

E&M Documentation

Split-Shared Billing

Screening Procedures

EUS Codes

Modifiers

Injections

Unlisted Procedures