All right, I'll invite our moderators to turn on their cameras and I'll moderate our Q&A session. So the first thing I want to clarify, great point, I did misspeak in my talk. When we were talking about global periods, ERCP has a zero-day global period, POEM, I meant to say POEM, has a 90-day global. The point of that specific segment was that CMS considers major surgeries those with 90-day global. So doing POEM with a 90-day global would automatically count as a moderate risk procedure even if the patient doesn't have any risk factors. But patient has risk factors and you're doing POEM and it's a 90-day global, that would count as a high in terms of your risk. Importantly though, it brings the question of a clarification about global periods and risk and the difference between major surgery versus the term procedure. So CMS in their examples provides what counts as moderate risk versus high risk in terms of minor versus major surgery. Major surgeries we discussed are those with 90-day globals. But just remember, the risk is determined by the individual provider. So when we talk about procedures, a regular endoscopy, for example, can still be determined to be high risk based on the patient's risk factors. Procedures like EGD, colonoscopy, when you document what about it actually makes it a high risk procedure. We have a question here about acute dysphagia and food boluses. Yes, you're doing an endoscopy, but you're doing it on an emergent basis. And that can count as high risk and depending on your PDR, your problems, data and risk, that could be a level four or level five. You're doing an EGD, which is a minor surgery on a patient with pulmonary hypertension, severe aortic stenosis. You'd write that the patient is at high risk for morbidity or mortality given those factors, pulmonary hypertension, severe aortic stenosis. And so that would count as high risk. Now in the case of a patient on GLP-1 agonists or SGLT-2 inhibitors, and you're doing an urgent procedure without the opportunity to hold them, that counts as high risk because they're at risk for euglycemic diabetic ketoacidosis. I'll invite Dr. Littenberg, Kathy and Kristen to add comments for a patient who you plan on doing an upper endoscopy for evaluation of GERD, and they have, let's say, AFib, and you're holding their eloquence 48 hours before the procedure, or they have diabetes and you're holding their SGLT-2 inhibitor or GLP-1 agonist to decrease the risk of euglycemic diabetic ketoacidosis, but this is an endoscopy being done on an elective basis as an outpatient. How would you characterize that risk for that patient given you're managing those medications for that patient? And as long as you have documented what the medications and the risk associated with it, I automatically assign the high risk, but then, and the key is for the providers to document those comorbidities because we're going to add that to the claim. And this is kind of where we don't see a lot of comorbidities documented by providers. That's the issue. You know, you look in the past history and you can see what the meds are and everything like that. And sometimes in the HPI there'll be something, but guys, that's not the important part to put it because what goes on the claim is in the assessment and plan, you know, so those conditions like number one, number two, or A, B, C, and D that you've got documented in your medical record, it's very important that you guys know that the first one is the most important one. So, and that's how most of your electronic medical record systems, et cetera, the first, second, third, fourth, that's how it goes on the claim, right? So only if the coders are looking at your notes and they end up manipulating the diagnosis codes on the claim to support what should be primary, et cetera, will that get fixed. Otherwise, we see a lot of times family history is the primary diagnosis when you're actually seeing the patient for iron deficiency anemia and they have other stuff and actually iron deficiency anemia should be primary, not family history. So as long as your documentation supports it and it's clear, we've been having, I'm going to tell you right now, we've been having, we've been seeing Optum, of course, that's one of, you might as well say UnitedHealthcare, is actually reducing initial hospital visits, 99223. All right. When you are taking the patient for emergency endoscopy for a GI bleeder that is unstable and even after reviewing those notes and it's crystal clear, you've got data, you've got complexity and you've got risk, they're still downcoding it. And all of these practices that we've been dealing with have to appeal it. Even with the documentation that's clear, it's driving us nuts. And they're not quoting anything in particular. They just said it doesn't meet it by CMS guidelines. By AMA guidelines, it's totally clear and CMS pretty well follows those guidelines. So even though you're crystal clear on it, we're still having to appeal and put it into a second round of appeals where it has to go to a medical director at Optum. So, you know, be crystal clear on it because this is, you know, when AMA revises these guidelines, they pretty well made it clear it's up to the providers to document complexity and risk, right? You know, so and I'm glad, I'm glad you guys are doing it. I mean, and Dr. Sun, you had very good information in that slide. But, you know, everybody has to follow through with it. If the average auditor looking at your claim does not have a medical background. And a lot of times we've heard this before. It's like they've got sixth grade medical education. So, you know, I've got a little bit, I definitely don't have as much of a background as you guys do. But as a nursing background, I know what supports it. So sometimes I automatically kind of give you that credit, you know, whereas somebody else may not. I don't think I have anything to add to that. I mean, there is no, you know, bright line exactly the difference between high risk and not high risk when it comes to the, you know, the patient's condition. And there's nowhere written down exactly what's a high risk endoscopy. You know, I mean, we know it. But again, it just needs to be in the record, either describing the patient as high risk for these reasons or the procedures high risk as inherently it is like many ERCPs or something about that particular situation, urgent bleeding, whatever it is. So the next question I'll direct to Kristen. So we have a question about documentation when you're attesting a note. And I know Kristen, you're going to be speaking deeply into how to document for split shared billing with an NP or PA. But the question we can answer now is, is attestation for a trainee different from split shared billing? What are the documentation requirements when attesting a note written by a fellow or a resident? OK, so, yes, it's completely different from the your attestation for a resident or fellow is more of a teaching attestation. I highly recommend that you pull up its CMS PATH guidelines. It's a document. It's very clear, straightforward. They give you clinical examples of how what your addendum should look like. It's it stands for Physicians at Teaching Hospitals. And as long as you review the note, you document in your addendum, you don't really have to do a lot of elaboration. If your fellow wrote an excellent note, it's best practice. Obviously, you're going to say, you know, I saw the I examined the patient with a resident or a fellow X, Y, Z. I was involved in the management. I agree with the assessment and plan or whatever written above. And then, again, any kind of personal observations that you want to add or input into that note. But it's definitely way different, because in split shared, you're dealing with two billing providers. Residents and fellows are in a training program. They are not billing those services. So when we look at split shared policy, you'll see that they the physicians have to have a lot more documented than just seen and agreed. Yeah. I'll tell you, from my standpoint, your attestation, the detail that you go into your attestation for a trainee, a resident, a fellow really depends on how well they document. If they've done a great assessment and plan, they've clearly outlined the medical decision making that goes to your level of billing. Then and they, you know, all the elements are satisfied. Then your attestation can be as simple as I agree with the above assessment plan and interview the patient in concurrence with, you know, with with the fellow. And I agree with what they've documented above. I still remember when I was a fellow, it was drilled into our head that we needed, you know, 10 physical exam elements, eight review of systems. But remember, all of that's gone away. So teaching your fellows and your trainees to focus on their medical decision making using the assessment plan to explain their thought process, why they're ordering such tests, why they're recommending the medications that they're they're recommending. That'll help you more than anything else. All right. We've got a question here about modifier 22. So we know that modifier 22 is for extra time in a very involved either procedure. The question, though, is whether you can use modifier 22 with the use of interpreter services. Do you want to take that, Kathy, or? OK, modifier 22 really is not on a visit. All right. So 22 is for procedures and kind of do a sidebar that and just a little bit. But if you're using a translator that goes to time, how much extra time did this visit take based upon that? You can't bill for the providing a translator. That's part of the ADA requirements. That's just considered the cost of doing business, in other words. But you can bill for that extra time it takes to complete the visit. And you guys were talking about this earlier. Time is based upon time reviewing records, time spent with the patient in discussion, coordinating care, and then also documentation of medical record. So that's where that time component comes into play. So the translator time and like I mentioned this earlier, be careful. Just say it took 40 minutes. Well, why? Because it took how much difference, you know, how much extra time to explain and answer questions, et cetera. That second example that I had on my examples is exactly what that scenario was, is that the patient really didn't have, you know, anything going on. But I mean, the majority of that time was spent with that translator and communicating with that patient. And you get to count that as part of your E&M visit if you're billing by time. We've got a question here about bowel preps and whether ordering a prescription for bowel prep for colonoscopy counts as a prescription management. I'll take that. If you're seeing a patient and you're ordering a bowel prep for their procedure, but it's a prescription, yeah, that counts as moderate risk because you're managing that as a prescription. If it's over-the-counter, that's no longer moderate risk. There's a question here about, I had a recent denial for a post-rectal ESD check after six months, denied after peer-to-peer. What do we do in those cases? So it was just a flat denial? I mean, we'd have to probably know the reason. I guess, is it a denial for the visit or for the procedure? So if you actually did a type of sigmoidoscopy to do a recheck on that, that goes back to medical necessity. But the thing is, is you would still be utilizing for the ESD would be a personal history, personal history code, if there were no margins. Or if there were margins detected, it would still be back to the adenoma or cyan-cy2 or whatever diagnosis. I have a feeling, was pre-authorization done? This is another question. If this was an endoscopy that you got denied, all right, and I think that's probably what it was, was pre-authorization done? We need to make sure that this is done in everything we do, even though you think, oh, it's just a sigmoidoscopy. I'm just doing a look at that. No, most of the payers do require pre-auth and then also verification of eligibility. And also, what diagnosis code was submitted on the claim, you know, too. But if you had a peer-to-peer after that, who was the peer-to-peer with? All right. So it was the visit after. But that was six months. So global's gone. Yeah. There was no, well, if you did enlist a code for ESD, which you pretty well should, that will have a 90-day global. Almost every enlisted procedure assigns 90 days. But I have a feeling this is endoscopy. And I saw a couple of you snicker. Yeah. Who's the medical director? A dentist? All right. Or, you know, is this another GI provider? Or even a colorectal surgeon or anybody like that? I mean, that's just. So doctors, I think you need to be the ones to kind of comment on this as well. Yeah. So we're clearly going to get a lot of questions about modifiers. There's a question here that if you have a same-day consult and procedure, is it still just that you bill for the procedure only? I love this question because we can clarify that and it'll help a lot of people. Yes, you can bill for both. Granted, your separate visit supports a significantly separate service. All right. So what that means is if you have a patient that comes in for that procedure, it's pre-scheduled, you're not billing a visit with that procedure. If it's a consultation and the decision led you to the procedure, you're going to put a 25 modifier on your visit. And that would be the significantly separate. I think we have some info on modifier 25 coming down. So I think we're going to discuss it anyway, a little bit further. Just keep in mind that you may be dealing with some payers that have specific guidelines. If you practice up in the Northeast area, Massachusetts, Blue Cross Blue Shield of Massachusetts has policy out there that doesn't matter what you do, whether you do a new patient visit or follow up, they will not pay for a visit on the same day of a minor procedure. All right. So, I mean, that's flat out policy for them. So you have to look at the policies by each payer to determine whether or not you're going to be able to get paid for that visit on the same day of a minor procedure. And many, many payers passed such policies only to rescind them in the face of broad protests. You're in an area where a particular important payer is giving you problems. I mean, try to work through your local state medical societies and see if you can push back because it's been successful in the GI societies and some states are fairly active on a statewide basis. So it's worth fighting these things. So we've been discussing the use of modifier 25, staying along with the use of modifiers when it comes to modifier 22, when it comes to the procedure itself, what needs to be documented to be able to justify the use of modifier 22? The question specifically states, could you use it if a colonoscopy took longer because the patient had 20 polyps that you then spent time removing? Okay. I'm going to, I'll kind of respond to this one. The problem with removing polyps on there is because the definition of CPT says polyp with an S behind it. All right. So it's taking into consideration that you might be removing more than one. If you're using the same technique, say you did 20 sneers in particular, how long did it take you to do those 20 sneers? All right. So CMS every year in the physician fee schedule publishes the pretty well time components based upon the pre-procedure time, the intra-procedure time associated with each technique that you do. Most of the time, and when you're looking at 22, remember it automatically goes into review box at the payer. They're going to request the records. They're going to look at the documentation. And some of them even say, don't even send a cover letter. All right. We're just looking at the note itself and there better be detail to describe why this took you more time. What was the complexity? So there's two components have to be met, complexity and time. So just because you remove 20 polyps doesn't give you enough to support it. How much total time did it take you to do it? All right. So if it took you, say your average colonoscopy takes you 15 minutes and this one doubled your time. So now it took you 30 minutes. That's still not going to meet the time components that are set down to determine the fee schedule for 45385. All right. So if you don't know that, it's very easy to find it. All you have to do is type in the 2024 CMS physician fee schedule and you get a zip file. And within that zip file, it gives you time components. And I would recommend that every provider has access to that, you know, highlight, just copy it, clip it or whatever, do a snippet so that you know what the average time is involved in your procedure. And we're talking intra procedure time component. And that's what you look at. So that's the best thing, that's your best resource. And so if it took you 30 minutes and they built a time component of 47 minutes into it, you're not gonna get any additional money. That's gonna be part of it. So when you do a modifier 22, it will drop to a paper claim at some point. It's gonna be, you're gonna have to submit a hard copy, which means it's gonna delay your reimbursement, right? Average time for a clean claim to be processed is five to seven days, all right? Anytime that you're gonna put a 22 modifier on it, you might as well put this out six weeks, right? And if your coders read through it, and anytime you see a 22, any of your doctors use a 22 modifier, the coders should be looking at it. If the coder's not impressed, it's like, oh, well, I don't see anything different. I mean, I do a lot with pediatric surgeons, right? And a lot of times they'll say, it was an extremely difficult case and it took double the time. I was just looking at one last night, it was a ruptured appendix. It took them double the time. So I looked at the start and stop time in the actual, the nurses, let's put this way, their diary in particular, where the incision start and the incision stop was, it took 45 minutes. Average time for an API is 65. All right, so I'm not, I took the 22 up. And you know, so that's kind of what I look at. So I'm not going to waste, let's put it this way, I want you guys to get it paid right away. And so if I don't see that it's gonna meet the requirements, then the payer's not gonna give you an extra money, then the 22 comes off. But that's the best way to look at it. Let's stick with this theme of time and billing by time. There is a question now, we talked about billing by time for procedures, or building that time in, in terms of modifier 22 for procedures. Let's go back to consults and visits for a second, billing by time. There's a question about if I'm working with a fellow or a resident, how do I take into account billing by time? Is it the attending, is it the time spent by the attending, or does the work and the time that the fellow had spent gathering data, reviewing data, discussing it with me, interviewing the patient, does that add up? It's time by the attending, time by the attending. That's because you're the one that's getting reimbursed for that service. And so the teaching, the residents or their fellows time, they could have spent an additional hour, unfortunately, that's just part of the teaching aspect of it. So it's just attending time. I mean, it goes back to our advice really, is for the majority of cases, you'd be able to justify your level of billing by the medical decision-making, particularly when you're working with a fellow or a trainee. Yes. Yeah, and attending time does not mean the time you're just sort of teaching. It really is the time that you're spending focused on the patient, interacting with the patient, discussing the specifics of that patient, rather than sort of generic teaching about ulcerative colitis or whatever it is you're doing. So yes, the complexity of decision-making is virtually always what you base your billing on in that situation. We have a few questions about how to bill for telephone calls to a patient. And I just wanted to dive into this a little bit more with Kathy, Kristen, and Glenn. The example provided in the question was for a cirrhotic patient where labs are ordered, imaging was obtained. Now that those labs and imaging results have returned and I'm calling the patient to discuss the results and future plan, can I bill for that work and that phone call? And is there a difference if the patient initiated the phone call and I don't bring the patient back in for an in-person visit within 72 hours of the phone call? So why don't we kind of both comment on this, Kathy? So the telephone, just Kathy said in our updates talk, the telephone only called the 99441 through 443, they're going away. They're gonna be deleted. There are those new CPT codes. That's payer specific, unfortunately. That's not gonna be across the board for all payers. I kind of thought that the example that you gave me, it almost also could be a good example of that principal care management service. And so those are different code sets and that's time you spent within a calendar, within the 30 day, or within that calendar period, that month that you can bill if those components are met, there's staff time and then there's provider time. So that also might be something. Kathy, do you wanna, is there anything? Unfortunately, telephone calls have gotten a little tricky now that the pandemic's over. And the thing is, it's nice of you to give that information, but pretty well, they say patient initiated is the key for telephone calls. And whether or not you decide to bring this patient back in, if they're coming within 72 hours, that's pretty well, you've lost that phone call. You're gonna get that visit. Some payers say 24 hours. Some payers go a little bit. So it is payer specific on that. Calling the patient to give test results is also considered part of the previous visit as well. You could bring that into the decision-making or data management in the next visit, provided, but the thing is, is if you ordered those tests to start with, if you ordered it, then the review of those tests and the information to the patients considered part of that order, initial order. So it gets a little tricky. It's good medicine, but unfortunately, we may not be able to do that. We may not be able to get reimbursed for that. And I think Dr. Lindberg's gonna talk about those principal care management codes and chronic care management, those codes that you tend not to, you tend to overlook or not even sometimes be aware of. Now, and there's a follow-up question here. Let's say I do an endoscopic ultrasound. There's an FNA result that's come back and I call the patient to discuss surgical pathology, the next steps, can I bill for that phone call or not? No. No. It's great patient care, but unfortunately it's part of your RVUs, I think built into the procedure. There's that post, there's that pre, that intro, that post. Yeah. If it's really something that you wanna make sure that the patient knows what you need to do, bring them in. Bring them in. Bring them in to discuss this further. If you're just saying, oh, your polyp was a hyperplastic and you don't have to follow up in 10 years. Oh yeah, you're not gonna bring the patient in for that. That's just information. But if it's really something that you need to discuss further, yeah, bring them in. Okay. Switching gears for a second, can we split a bill for difficult procedures if two physicians were involved in the procedure? For example, a difficult endoscopic subucosal dissection or EMR with an interventional EOS case. You're talking about co-surgery. All right. So if two surgeons work together, and you guys are considered surgeons. If two surgeons work together on the same reportable procedure, only one of you gets it. And it should be the one that actually completes it. All right. So, but, and of course, documentation is key. Whoever, you both have to have some type of documentation. But if there's two different cases, specifically two different procedures, one of you does an EOS and the other one actually does the procedure as long as it's not a procedure that contains the EOS component, each of you can separately bill for those procedures. So I don't know if that's exactly what the question is, but, okay. So like a difficult ESD if two DACs work together on this one, that's going to be unlisted procedure. All right. To start with, it's not going to be awarded the 62. All right. So this is kind of where you want to do a departmental split. So one submits the bill and when you get the money, you divvy it up accordingly. And that's another option as well. Yeah, that's tricky. I mean, other instances where, let's say you're doing a colonoscopy and you have a colorectal surgeon, you're doing this in the OR and the colorectal surgeon is then doing a hemorrhoidectomy, let's say, for example, then one would have an opportunity to use modifier 62, correct? Depending on the procedure, not all of them, not all procedures will offer 62 and it's actually the same reportable procedure. So two surgeons work together and are integral. Each one has an integral part of that same surgical procedure. So if the colorectal does hemorrhoids, you do the colonoscopy, you have two separate procedures, no modifiers are required. Right. Okay, so you brought this up. So let's talk about a TIF. All right. So if a GI is working together to do the fundamental application and general surgery is doing the diaphragmatic hernia, which is reported as a parasophageal hernia repair, that parasophageal hernia repair includes the statement, includes fundamental application any method, which means if GI is doing the fundamental application, then GI is part of the general surgery's diaphragmatic hernia repair. All right. So then that means each one of you would bill the diaphragmatic hernia repair with a 62 modifier. Your note would indicate the fundamental application and we see Dr. So-and-so's note for the parasophageal hernia back and forth like that. Then you each would be considered a component of that one reportable procedure. All right. When two different specialties work together, you're more likely to get paid with a 62 modifier provided it was preauthorized at the time of scheduling. Since that's usually an elective procedure, it gives you the opportunity to preauthorize for both components. It gets tricky. That's part of my advanced talk, too, to try and discuss that a little further. But yeah, two different providers work together on the same specific procedure. It is considered a 62 situation. So it could be. You could get paid on it. But most of your GI codes do not allow co-surgeons. The only one that does is PEG placement. That in most payers, I think, most Medicare payers still requires two different specialties to be doing the procedure. So if you have a GI colleague in your GI practice and you're, for whatever reason, you're both doing the gastrostomy placement, you can't build a co-surgery situation there. The only time that they will maybe take a look and allow for that is if there truly was a medical reason, say the patient had previous radiation treatments, et cetera, and you really needed somebody from the upper approach and the percutaneous approach to do that. But it really has to be documented well or to get paid for both. We have a question about billing for hemorrhoidal banding. If that's discussed later in the course, then we can talk about it then. If not, could you discuss billing for hemorrhoidal banding in the office? Hmm, well, I'll touch on it, but we won't really talk a lot about it. So it's billable. I think the visit on the same day of the procedure is the one thing in question. Hemorrhoid banding also requires medical necessity. And there's some information given from vendors, and we all know that, that just because the patient has multiple hemorrhoids, there should be medical necessity to band them. If the patient had one, and then you have the patient come back in two weeks to do a recheck, and at that time, the patient is still having symptoms, and you go ahead and band that, and that's well-documented, the banding should be appropriate. Remember, though, this is a procedure, which means you still have to document it in procedure form. You have to have the indication. You have to have the technique. You have to have the grade of hemorrhoids documented, the method, and the plan with recommendations. It's a formal procedure. Nope. You know, not that two bands were applied, blah, blah, blah, that's it. Nope, it should be a formal. We have had some payers that have been looking at this more closely, and one of the payers is Blue Cross Blue Shield. They're looking at medical necessity for each additional one, and that's actually what the issue is. So make sure that you put down, not just here for hemorrhoid banding, make sure that you put down what the patient's signs and symptoms are, what the response was from the previous bands, all right? All right, not that just they have a hemorrhoid and we're gonna band it. Kristen, you wanna have anything else to add? I think that's, I can't stress enough. If you are doing a hemorrhoid banding, you need to give us the grade of the hemorrhoid. I don't know how many times I've seen just very short one-liners for a procedure and nonspecific, and also, even though, double check, even though you might've said grade two hemorrhoid, make sure that that diagnosis transfers over to the claim as grade two, because a lot of times providers will document the grade and then they go and look for the diagnosis code and they're telling the computer hemorrhoid, and oh, here's a hemorrhoid, so here, assign it, because I'm busy. And the first one that pops up is gonna be unspecified because you didn't tell the computer what grade it was. So just be careful with that. And this kind of triggers the next thing, denial reasons. All right, one of the things is lax medical necessity. All right, so we're seeing more and more payers with a nonspecific ICD-10 code that gets assigned on a claim which will trigger denial. And remember, every time the claim gets denied, it has to be reprocessed again. It costs the practice anywhere between a 25 to $100 per MGMA, kind of, they've been, they always pretty well publish that on a yearly basis. And it depends upon the denial reason. And I'm gonna tell you, I know most of the physicians and providers listening in have never seen an explanation of benefits. All right, so that comes along with the remittance and it tells whether the claim's been paid or not. And if it's not, sometimes there's five, six, seven denial reasons on it. And you gotta figure out why it was denied. And there's some quirky denial reasons, you know, and most of the time, most of the time the diagnosis code is the issue. All right, so please be specific with everything. Abdominal pain, unspecified, don't even get both of us started on it. And I'm gonna go into a lot of detail on the diagnosis codes, nonspecific diagnosis codes, things like that. Great. I do see we have a few more questions. I will be saving them for our next Q&A session or we can answer them offline. It is 9.46 central time. So we are going to move on. Maybe we can do one more question before we go on break. So this is a question with regards to pre-procedure phone calls prior to a procedure. Is there a code that an RN can build for that phone pre-procedure education and prep instruction? And I see Kristen shaking her head. No, I'm sorry. Confirming, yeah. That's just part of the, it's part of running a good practice. And be careful, just don't say, okay, well, if we can't get paid for a phone call, we'll bring the patient in. No. No. All right. Nope, can't do that. Even pediatric practices always like to do a lot of times a recheck on a patient that's been scheduled 24 hours ahead just to make sure there's no fever or anything like that. That's also considered part of the procedure is not separately payable. There are some practices that have set up for patients who have open access or direct access. You know, they're not seeing the patient ahead of time to see them and evaluate them. They're doing all the work remotely and then doing the procedure. Some practices do have an administrative fee that's outside, not paid by insurances. There's just a retail thing you do with the patient. But, you know, you offer them, well, if you don't want to do this, don't want to pass that interview, come in and have a visit. We'll, you know, do that then. So you could potentially incorporate that into an administrative service fee of some sort. You know, if you're the only practice in the area that does that and everybody else doesn't, that could be a disadvantage in marketing. On the other hand, if you're the primary GI group in that area, that may be something you could do and clearly can generate revenue. Just one other question before we go on break. Are email or chat or text communications billable? What if not telephone, but a quick video call for results follow up and not formal visit? There's a lot to that question. Let's first answer the whole email, chat or text communication. I'll be talking about that and the stuff you forget to bill for session if you want to defer that for a bit. All right, great. Let's take a break. We will come back at 10 o'clock central time, 11 o'clock Eastern time, and we'll see you then. Lots more to come. The next session will actually be about screening versus diagnostic colonoscopy. A very, very common question. Lots of questions that come up about this. We'll see you soon. Thank you.

medical billing

documentation

surgery risk levels

global periods

insurance denials

procedure modifiers

payer-specific guidelines