2025 Gastroenterology Reimbursement and Coding Update (Virtual)

01 - 2024 Breaking News

Pdf Summary

The presentation covers significant updates impacting gastrointestinal (GI) practices as of 2025, focusing on current procedural and coding changes. Key updates include alterations to the Ambulatory Surgical Center (ASC) and Physician Fee Schedules, with ASCs receiving a 2.9% payment rate increase and the Physician Fee Schedule seeing an average payment rate reduction of 2.93%. The CMS Screening Colonoscopy update expands colorectal cancer screening coverage, removing barium enema methods and including computed tomography colonography. <br /><br />Telehealth services have been extended through 2025, allowing audio-only communication if video is not feasible for the patient. New Current Procedural Terminology (CPT) codes have been introduced for various telemedicine services, though CMS marks some as unnecessarily duplicative. The presentation also details specific GI coding updates for the ICD-10-CM, effective October 1, 2024, with new codes covering obesity classifications, anal, rectal, and anorectal fistulas, and revisions to the personal history of polyp codes facing denial issues under Medicare plans.<br /><br />The session includes information on new legislation in Illinois requiring insurance coverage for all medically necessary colonoscopies. Lastly, the new G2211 code addresses visit complexity in evaluation and management, focusing on longitudinal patient-practitioner relationships, especially in cases of chronic or complex conditions like Crohn’s disease or alcoholic cirrhosis.<br /><br />Overall, the material stresses the importance of staying updated with frequent changes in medical coding guidelines, telehealth expansions, and legislative adjustments to ensure compliance and optimized patient care in GI practices.

Keywords

gastrointestinal practices

procedural changes

coding updates

Ambulatory Surgical Center

Physician Fee Schedule

telehealth services

CPT codes

ICD-10-CM updates

colon cancer screening

G2211 code