2025 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2024-16 - Top 10 2024 Coding Questions Received by ASGE

Pdf Summary

The document outlines answers and guidance on common coding questions in the medical field, specifically related to billing, documentation, and procedural guidelines. Here is a summary of the top questions tackled:<br /><br />1. <strong>Fibroscan Billing</strong>: The choice between billing codes 91200 and 76981 depends on whether the equipment can generate a true ultrasound image. Stick with 91200 if only using the probe without a true ultrasound image.<br /><br />2. <strong>Billing Without Credentialing</strong>: Using another provider's identification to bill for an uncredentialed provider is considered a false claim and is deemed misuse by the Office of Inspector General (OIG).<br /><br />3. <strong>Imaging for CPT 74328</strong>: Radiologic images must be documented and saved as part of reporting requirements for bile duct image interpretation during ERCP.<br /><br />4. <strong>Infusion Billing by NPs</strong>: Infusions require a provider onsite; if conducted by a Nurse Practitioner or Physician Assistant, services may be billed at a reduced rate. State laws may vary.<br /><br />5. <strong>Code G2211</strong>: This code can be utilized for long-term care plans but should not be used with a modifier 25 for acute issues.<br /><br />6. <strong>Colonoscopy after Positive Cologuard Test</strong>: A positive Cologuard test in patients at average risk is a screening, taking into account personal and family history for increased risk.<br /><br />7. <strong>Reason for Visit Documentation</strong>: The chief complaint must be clearly documented to ensure the visit is billable.<br /><br />8. <strong>Signature Timeliness</strong>: Signatures are required at the time of service, with any amendments being clearly documented.<br /><br />9. <strong>Colonoscopy Documentation for Positive FIT</strong>: Explicit documentation of "screening due to positive FIT" is advised over simply stating "occult blood in stool."<br /><br />10. <strong>Colonoscopy for History of Polyps</strong>: Surveillance is determined by the type of polyp and other clinical factors, and not performing the colonoscopy within suggested intervals does not change its surveillance nature.<br /><br />The document emphasizes adherence to updated coding guidelines and documentation standards to ensure compliance and proper reimbursement.

Meta Tag

Concept FibroScan

Concept CPT 91200

Concept CPT 76981

Concept Credentialing

Concept Incident-to Billing

Concept HCPCS G2211

Concept Lower Endoscopy

Keywords

medical coding

billing guidance

documentation standards

procedural guidelines

Fibroscan billing

false claims

CPT 74328

infusion billing

Cologuard test

signature timeliness

FibroScan

CPT 91200

CPT 76981

Credentialing

Incident-to Billing

HCPCS G2211

Lower Endoscopy