So, we're going to talk about some of the other E&M things that people often are doing but often forget to bill for, or with a little modification of how you do what you do, would be billable services. And these have not changed a whole lot, but what is going to change in 2025, and not reflected entirely in this slide set that I'm going to talk about, is the telephone services. And when I get down to that, we'll talk more about what the status of that seems to be now and what we can do or can't do to compensate for it. So, this is another R-rated feature with no conflicts here. This question was kind of raised a little bit before or addressed a little bit earlier, but I wanted to ask and see what you answer. In recent years, a percent of complex new patients in GI in your practice is about what? Five percent, 15 to 20 percent, 25 to 30 percent, or almost a third or more of your patients. So these are complex new patients. In other words, these should be level five patients. What would you estimate from your own practice is the situation? Okay, well, only, you know, a fifth of you said around five percent, and many of you said 25 to 30 percent, or at least 15 to 20 percent, which is really quite different than what the data that was shown earlier seemed to indicate, where about five percent seemed to be billed at level five. So I hope this is true, that that's actually how you're billing, but you ought to really run reports on your own situations and see for new patients, what's the distribution? For follow-up patients, what's the distribution? And if it's really like that benchmark data that was shown earlier, then you really need to look hard and do some more provider education. I mean, for example, the level four follow-up visit, I mean, is pretty much somebody with ongoing symptoms, they're not at treatment goals for their condition. And for a huge percent of our patients, we're seeing back, you know, in our offices, established patients, whether they have irritable bowel or GERD, whatever it is, many of them are not completely asymptomatic. They probably wouldn't be needing a visit if they were. So if they're not really at goal for their problems, and what about all the fatty liver patients, the IBD patients? I mean, most of those wind up being able to warrant a level four follow-up service. And we seem to be, I think, still drastically under billing for a lot of what we're doing. But there are other things also that we should be doing or should be billing for. And I'll go over some of those. So I like this picture from a Turkish grave from, I don't know how long ago, but I think it means life is short, coding is long. Maybe not. I may not be interpreting that right. But Ed's son kind of pointed to some of this data about the lack of physician updates in our fee schedule. And the commercial payers have been following Medicare pretty closely. So adjusted for inflation, you know, our physician payments have declined nearly 30% over the last 20 to 25 years compared to the cost of practicing. And this creates huge problems for us and just tremendous financial and efficiency pressures on us. Also, I think, makes it difficult for us to hire the numbers and qualifications of staff we'd like, et cetera. And as he also pointed out, we're not making any progress since last year. Looks like we're facing another roughly 3% cut in fees unless Congress coming in next year decides to reverse that in some way. There was a bit of a recovery from the last threatened cut. We got not quite as bad a cut last year, thanks to congressional action. But it's kind of doubtful that that's going to occur now. So we've seen a steady decline in the conversion factor. And just like this little picture here of beautiful Palos Verdes in the southern part of Southern California here, where the ground is just collapsing as we speak, land is shifting about a foot a week in some of these residential areas. Unfortunately, that's what's happening in a lot of medical practices. And the answer to that is practicing more efficiently and more effectively and smarter. So the second question is, the percent of level 5 billings, is it comparable to other medical specialties, true or false? And then this is not your data, but just what you think is true, generally speaking. Are we seeing patients as complex and billing as complex as other specialties? Yes, if you think we are, and false if you think we're not. Okay, so not quite 2 to 1, but most of you thought that was false. And that's correct. We are not billing at levels of most medical subspecialties. Most medical subspecialties bill level 5 services significantly more than gastroenterologists seem to be billing. So maybe your own practices are exceptions based on the prior question. But as a specialty, looking again at that benchmark data from recently, we're billing about 5% of new and follow-up patients as level 5. And I don't think that's fair. I mean, we're treating complicated patients. I mean, even the ones who don't have immediately life-threatening problems or going into the hospital, I mean, they have serious degrees of irritable bowel or other functional disorders. Some of them are very complicated people to deal with, with, you know, their stresses, their various depression, anxiety disorders. And unfortunately, we're often called on to try to help manage some of those problems, not just bounce them back to their primary doctor. So we need to do a better job recognizing our complexity. And I summarize an old quote of Oscar Wilde by saying, our glass is half the size it needs to be between the fee cuts or failure to keep up with inflation and the way we're looking at life. So we need to be careful not to let stuff slip by, things that slip through the cracks that we're doing and we just don't remember to bill for or code for. So I call these the other codes. And if you haven't seen the revised 3D version of Coraline recently, there's a treat waiting to happen for you if you can find it. So larger GI groups have a lot of different revenue sources other than their professional services these days. And when we're talking about the opening slides, we're really talking about what's happened to professional fees. But I mean, a lot of us have made up lost revenue by having lab and pathology as partial replacement, having some interest in ambulatory endoscopy facilities as partial replacement. Some of us have anesthesia services. Some do research. Some have nutrition services, chronic care management, which I'll allude to but I'm not going to talk a lot about today, or even have in-house pharmacies and are doing dispensing. The rules from this seem to be somewhat more permissive and I think more practices will get involved in doing that. So yes, all of these are other ways of making up for falling professional fees, but we should not let lapses in professional fee billing hurt us if we can get around it. So we'll visit the Center for Forgotten Information and see what we can come up with here. One of the services I've talked about each year for quite a while are transitional care services. I'll go over those again because I still think they're very little utilized in GI. We'll talk about the things that are done through portal or other electronic means and what's happening now with telephone services. And I'm not talking about E&M telehealth visits where you're seeing the patient and then substituting for a visit, but really more the between visit online services or telephone services, which unfortunately looks like the changes there are going to put us at a disadvantage as of 2025. Not so much because of what Medicare has decided, but because what AMACPT decided much against our advice. I will touch on chronic care management mentioned once again, home health certification, recertification, care plan oversight. These are things we do certain amount of some practices more than others, but very, very commonly forget to bill for. And other things that you can be doing in your practice and many of us do to one degree or another that are not E&M services, they may not be forgotten services, and they can often be cash services. I mentioned earlier the notion of an administrative fee for helping patients with open access colonoscopy. So instead of having to have a visit in the office, you're doing what data gathering you needed to assess the patient's safety and ability to safely undergo endoscopy and getting it set up without a face-to-face visit. There's no reason you shouldn't be billing and getting paid for a service for that. You're doing the patient a favor really, and you're providing a service of some reasonable complexity. Some of us do sell our own prep kits, not so much for colonoscopy, but there are a whole variety of supplements that some of us make use of treating mainly functional medicine patient problems. Breath tests are relatively sophisticated and many of these are not covered by insurance, but can help us managing some of our functional patients. Nutrition services, I think there is a role for gastroenterology getting involved with some of the GLP-1 drugs if we can get our programs set up. So sort of integrated health practices, even behavioral health ought to be incorporated in many larger GI practices. Focusing on transitional care, these are situations where patients are being discharged from the hospital and instead of just simply showing up in your office whenever that gets arranged for for a follow-up visit, you jump through a couple of small hoops and manage to see them either within a week or two weeks and perform what may be a moderate or high-level decision-making service. The amount that you can get paid for doing this right and billing under code 99495 or 496, transitional care management, substantially higher than a typical office visit. $200 for the 40-minute roughly service or $278. So usually more than a standard office visit. But what these require is a certain timeliness of the face-to-face visit. Face-to-face can be telehealth. Medical decision-making, at least it's moderate complexity. But again, any patient coming out of the hospital almost certainly is not going to be at goals of care for what their problems are. And many of them do have high-level medical decision-making involved in that assessment at follow-up. They come out with poorly compensated liver disease, IBD that's been flared up. Maybe you've changed therapy or you're aiming at doing that, things of that sort. But there also needs to be a communication service, which can be a phone call, an email exchange or just with your staff, a face-to-face brief visit within two business days of discharge. That's kind of the key. Now that means you don't count weekends and sometimes it doesn't occur, but you have to at least be reaching the patient to try to get that arranged for. And there are a couple of things then that you're going to get done in that communication that are just kind of routine parts of follow-up care. So the date of the service that you bill can be the date that the follow-up visit is done, but it's sort of a bundle of services for a 30-day period. Now, most of us are not going to see the same patient back more than once in that 30 days. But if you see that patient once and it's not 30 days, but within 7 or 14 days, then you should be able to use a transitional care code if you get things coordinated properly. So the components are that interactive contact. You need to have your staff make that interactive contact and that means the person who is managing the patient in the hospital needs to make sure staff knows, I want this patient to have a transitional care visit. Please reach them in the next 48 hours of discharge. I expect they're going to go home tomorrow. You know, make sure they're reached within a couple of days. And what do they do? You know, however you can reach the patient, at least document two tries within two days and keep trying until you succeed. And what you do is you do, in effect, like medical medication reconciliation, making sure the patient got their prescriptions, that an appointment date is set up, you know, you can work ahead to just make sure any pre-certification for the visit is needed, is obtained, all those kinds of things. Things you're going to do anyway, okay, but just trying to make sure they're done in that timely fashion. And then the actual face-to-face visit occurs and then you can use those transitional care codes. So let's talk about telephone services. For years, after a lot of pushing folks to be using these services, I think we had accomplished a pretty fair amount of telephone management services. And of course, during COVID, we were able to use these telephone services, audio only, to substitute for a lot of otherwise in-office visits, face-to-face visits, patients who can't manage video in their telehealth, they don't have the bandwidth or the devices. And these have been tremendously helpful, have expanded access to care, made it much easier for patients. The problem is these codes are now going away. And we didn't know what the final status of these would be until Medicare made its decision that they're not going to acknowledge the other codes that Medicare has passed in their place. And there is a whole set of codes that now Medicare is putting in place, or CPT is putting in place, and Medicare is not going to acknowledge. So we're kind of left with this strange situation where we do have some acknowledgement of telephone services, audio only, for a while longer with Medicare, we believe. But with private payers, if they don't keep these codes around, even though CPT says they're being deleted, if private payers don't recognize these codes anymore, we're going to have very limited ability to provide these kinds of services or other telephone services. So an example of what we've typically done, you've had a patient who you saw for, let's say, constipation, you prescribed Miralax, Fiverr, et cetera, you urged them to do a follow-up visit in six months. A month later, okay, it has to be more than seven days, but let's say a month later, they call and they indicate they're not getting improvement, they want to know what else to do. You can schedule a telephone visit and counter, or you can just simply call the patient back even without a scheduled appointment. And then it really depends how much time you spend on that service. But if you spend, let's say, 15 minutes discussing maybe further tests, further therapies, you create a brief note with all of the typical stuff that goes into an EM note, you can be billing based on time, 99442, because of the 15 minutes plus other time you spent with coding. So this has certainly been an advantage where not too many years ago, it really wasn't anything we could do. We just sort of handled the interface and just, you know, we didn't bill anything extra. The Medicare rules say it can't originate from a visit preceding within seven days or lead to another service within the soonest available timeframe. In other words, you don't immediately schedule the patient for another visit as soon as possible. You may tell them to come back in, you know, another month or two months instead of the original idea of three or four months. But if you want them in as soon as possible, then this extra service wouldn't count. And before, you could do for new or established patients during the public health emergency, but it no longer is applicable for new patients under Medicare. And this service needs to be patient-initiated, okay? The providers can certainly help let patients know it's an option to be able to have these kinds of services conducted by phone, but make sure they're aware there will be a co-pay. Though if they have a secondary insurance, it won't usually be a problem. So they're legit. And up till through now, these paid quite well. They had RVUs that were pretty respectable, 0.7 up through 1.92 for the three levels of telephone, and the payment rates at the national payment rates anywhere from $56 to $128. So they're, you know, quite comparable to a face-to-face or video visit. So this is where if this whole set of codes goes away, it's going to be problematic because there isn't anything easily comparable in value to replace them. And I'll get back to that in a little bit. Now there's another set of somewhat comparable services, but where these services are carried out kind of online. A patient sends me a portal message, and I respond to that, and then they may respond to me, or I may call in a prescription, or I may order some lab, or do some other services within a seven-day timeframe. And the whole bundle of services then can be billed for with the codes 994-2122 or 23, whether it's 5 to 10, 11 to 20, or 21 or more minutes. So these are referred to as online digital evaluation and management services for established patients. These aren't for new patients, and it's for up to seven days. So it's sort of the cumulative time during a week that you spend. And like the telephone services, it can't be immediately after a visit, like the first seven days. If you have some exchange with patients by portal, that really doesn't count. And even if it's patient-initiated, the exception is if they're in touch with you about a new problem, something you were not dealing with at the last encounter. Could be an old problem that wasn't pertinent during the last encounter, but it has to be a new problem, or the old problem beyond seven days from the last visit. So an example, similar. You see a patient about their constipation. You discuss fiber, Miralax, maybe medication. Patient sends a message later, months later, they're not helped enough. You spend maybe seven minutes going maybe back and forth over a few days about adjusting their medications. You record a brief message. Your total time is maybe 12 minutes between the interchanges and your documentation, or maybe sending in prescriptions. And you can bill a 99422 code for that service. You're not immediately setting up the patient for a follow-up visit. Again, it's sort of a standalone substitute for what otherwise had been a visit. So these three codes have timeframes of five to 10, 11 to 20, 21 to 30 minutes. I can't say I've ever billed a level three in this sequence, but it's not unusual that I've been billing level one, level two in this sequence. These are not supposed to be by, you know, Yahoo, it's supposed to be by a HIPAA compliant portal. That's how most of our patients communicate this way. If I happen to get an email through some other method, I sort of reroute the patient and get them into our EHR so that they're in an appropriate HIPAA protected environment and safe from being hacked. It's established patients only, must be patient initiated, can't be immediately related to a prior E&M service unless it's for a really new problem. And it can be once reported for a seven day period of cumulative time, starting with when the physician answers the first inquiry. Okay, so you don't count the time you're actually reading that initial inquiry, but when you're starting to answer and then things may go back and forth. If it consumes more than five minutes during a seven day period, then it is billable. But keep in mind that the reimbursements are much lower than if you're doing a phone service of an equivalent complexity and duration. Okay, so the old telephone is much to be preferred if payers will continue to recognize these old codes. And we're hoping with Medicare, at least we get another year of reprieve. Commercial payers, we're not sure what's going to happen. So there are other stipulations. If you're gonna be using these, you should read more of the CPT manual to see what the exceptions are so that you're not double billing when other things are being done. Certain chronic care management is really kind of redundant with some of this. The chronic care management is sort of takes the place of and has a much bigger service if they're complex patients than these small visits. Now, CMS a few years ago with COVID, began to recognize codes that they put G codes out for, G2010 and G2012. And this had to do with remote evaluation of either recorded video or with a brief communication check-in, just kind of what they called a virtual check-in. So a patient who was just kind of following up on something to let you know how they're doing or had a simple inquiry. And these could again, not come from an immediate preceding visit within the seven days or lead immediately to a follow-up visit. And for the G2012 had to involve five to 10 minutes of medical discussion or more. So you couldn't report it for less than five minutes. So when we looked at this G2012 code, we thought, well, the telephone service would really pay a lot more. So there wasn't really a great purpose to use this G code. On the other hand, you do have patients who send you sometimes pictures of interesting things you'd maybe rather not see coming in your video, but you look at them and you report, no, I think that's just some beets you ate a couple of days ago that you're showing me a picture of your poop and just see if this goes away. Okay, but we have a way of actually charging for that kind of a conversation. So there is now a 98016 code that replaces the G2012, a brief check-in service. And again, must involve medical discussion of five to 10 minutes. I'm not sure what medical discussion means exactly. It doesn't seem to mean the total time you spend related to the encounter. Like it doesn't clearly reference what you spend doing your charting or other services. It seems to require five to 10 minutes of kind of direct conversation with the patient, but it does replace the service. And if any particular payer stops you from using telephone services, this is about all we have left other than forcing a visit, either a full-blown telehealth video visit or an in-office visit with these patients. Keep in mind that if some of these services become simply non-covered, never covered, you can still bill patients for these kinds of services, but we may have to use unlisted codes. This is all stuff we have not had time to really discuss and figure out what to advise you about. It's evolving because we didn't have the final rule for Medicare until just a little bit ago. So we have the 2025 AMA CPT getting rid of the telephone services, recognizing this 98016 and a bunch of other codes for audio visits, but they're all lengthy, minimum of 10 minutes. So the new services that CPT codes recognize that Medicare don't recognize are probably where you're gonna have to go for your lengthier services like this for commercial payers, but you're just gonna have to keep an eye on what happens with your billing and coding and denials as these transitions occur this year. So an example of a G2010 patient, which may be a little bit less unpleasant, is you've seen a patient for inflammation around the PEG site. It doesn't seem infected. You advise them to use a barrier cream and you ask them to send a follow-up photograph of the PEG site a few months or a few weeks later. They send it to you, you look at it, you see it's all healed. You let them know by call or by portal message that the site looks good. They can just follow up as needed. You create a brief note. So that's a typical G2010 service that you can bill for. Doesn't pay a lot, but it pays something. And before it was something you couldn't do. And what about a 98016 case? Again, that constipated patient, they send you a message that their constipation and hemorrhoids have improved. And you just get back to them saying that, continue the fiber, dry as needed, Miralax or other things. You might give them some other advice, but it's gotta take more than five minutes of medical discussion. But some phone calls get rather long when the patient meanders and you have complex answers to give them. But again, you gotta write a brief note and then you can bill the 98016 service. So in our EHR, we'd call that a chart note. So it's not set up as a visit, it's just set up as a chart note. And it may just start out as a task coming in my inbox. Patient would like a call back about their constipation. And then as I realize it's turning into something more than five minutes of my total work, I just click the chart note, set up a new note, and just put all the text of that and my answer into that, and then task my biller to bill 98016 for diagnosis of constipation or whatever it is. So you gotta figure out the workflow in your own EHR. It's different than a typical visit. You may be tasking your biller to do something rather than just closing your note and expecting it to go in automatically. It just depends on your own situation, what your own EHR does. So again, this change in the virtual check-in to a short service of five to 10 minutes, and then there are other codes that will be available at least through CPT, yet not recognized by CMS for the lengthier audio-only services. So keep in mind this growing complexity around this whole business. So the new code is worth about $14, whereas the code for the PEG redness is $12, but it's certainly far less than the visits that were done by audio-only or telephone services. And well, I haven't seen the actual valuations that are coming for the CPT codes that Medicare is not recognizing for audio. There were RUC surveys, what the final values were. I don't have off the top of my head. I expect our societies will be publishing a update on all of this stuff that will include more instructions and more of the expected reimbursements on some of these services that again, won't be Medicare recognized, but will be probably through the commercial payers. Another set of codes that sort of came about during COVID was this notion of e-consultations. And this is really between medical professionals, a primary care doc reaching out to a specialist is what's typical for just something that they need to know about how do I manage this patient? And it could be either inside a large multi-specialty group like many academic centers, or it can be outside where a primary physician who is maybe in my neighborhood wants to reach me as a GI doc. And so I get some records and then I get back to them. There is a code 99446 for this, but it involves a verbal and written report back to the patient's treating physician. Five to 10 minutes, well, okay, but I got to create a written note and get that sent off. And there are higher level services for longer lengths of time, but this involves a written report. So the medical consultative time minimum is five minutes, but it does involve a written report, which may not be worth it for the amount of reimbursement that it has, but at least it is an option. So an example of this would be a patient who has diabetes, nausea, vomiting, constipation, in and out of the hospital. They live remotely from you. They're in a rural area. The local PCP wants to consult with you and try to get a sense of what's the right workup and management. So they send you a bunch of records to review, and then you have a brief verbal and a written report back. So you can bill some code based on the length of time you spend. And actually the consulting primary doc can also bill a 99452 if they spend more than 15 minutes, baseball, 16 minutes preparing the case for your review. Now, if this paid a lot for everybody, this might be a really good thing. The problem is it really doesn't reimburse all that well. So when you do a brief service of this sort, it may have value if you don't have to review a whole lot of records, but there it is. There are codes and there are Medicare rules. You can't bill this when you are arranging a face-to-face visit or it immediately follows a face-to-face visit. Here, the path is 14 days before, 14 days after, rather than seven for the other services. It can be used for new patients, not just for established patients. And those are Medicare rules. To my knowledge, commercial payers are acknowledging these, but we don't have a lot of feedback from our physicians to let me know that for sure. And the code for five to 10 minutes where you don't have a written report back to the doctor, there is a code 99446, but it pays only $18 nationally. And the referring doctor who spends more than 16 minutes basically doing this only gets paid $34. So it's not taken off. And even within academic centers, I think Ed might be able to answer if it comes up during the Q&A. I think they've looked at trying to make this work within their multi-specialty center. And it just hasn't really taken off very well because of these restrictions on reimbursement. So what we're trying to do as a tri-society is to try to keep as much leeway as we can on the services of telehealth, visual and audio that were approved during COVID-19, but we recognize many of these are going away and we're still lobbying Congress to try to expand them and make them more permanent. And we're trying to maintain parity for video and audio only services. And I can tell you that the ruck value for the audio only are not quite comparable to the video or in-person visits, but we're doing the best we can. So what else is there? Without going into detail, if you have a group that can either engage some of your own staff to be doing patient follow-up and creating notes and have protocols, or work with an outside company that does chronic care management, this can really be substantially useful. There's a whole variety of codes. Some of them doesn't involve a lot of physician or staff time in the office. Some of them are more complicated and take at least 30 minutes of total time to monitor patients remotely. And there are further codes that have to do with actual monitoring of physiologic parameters, whether it's things like weight and blood pressure through devices that transmit the data back to the physician's office or other possible types of parameters. We've set up chronic care management within our own group. We're using an outside entity that actually does the service and we've worked out a contract with them so that some of the professional aspects of it are part of the fee and part of what they do is covered by part of the fee. And then these are commonly monthly services on patients who have either one or more principal severe problem, which we can now do, called a principal care management, or they may have two or more ongoing problems that constitute a serious threat to health. And we have a pretty fair number of patients enrolled in this and it's working well and it's a pretty good revenue source, but it's not easy for any kind of small practice to try to set up and do on their own, but there are outside entities that can help. There are codes for home health certification or recertification, they're G codes, but these pay on the order of 60 to $70. So some of us do receive these documents from home health companies wanting us to review and sign them off. And most of the time we've just sort of signed them and sent them to be faxed back without thinking about it very much. But when you get these from agencies of patients you're caring for, then you can bill this and it does get paid at quite a substantial rate for the amount of time it takes. Some of us oversee home TPN patients or home enterally fed patients. And we're basically looking at their care plans from the home health agencies. And we often are in touch and doing adjustments through the home care nurse or new prescriptions or lab monitoring and that sort of thing. And these are monthly services, which can again pay a pretty substantial amount. What we do day to day often, but forget to bill for, we're often still counseling patients about tobacco cessation. And if you spend even three minutes discussing this with the patient, there is a code 99406 with a G code 9906 for these patients. And if it's more than 10 minutes, it's even more. I don't spend more than 10 minutes on tobacco counseling, but it's not infrequent for smokers. I will spend time on the shorter tobacco cessation counseling. And I put this code up in sort of my favorites of CPT codes. So when I'm creating my coding, it's kind of there staring me in the face. And if I know this patient was a smoker and I spent a while talking to them, it takes almost no time to document you spent X minutes discussing tobacco cessation, and then you can code and bill for it. Little bit of money, it's not large, but anything you do that way is good. The G2211 code you've heard discussed earlier today, and if there are questions about it, I definitely want us to get into more on the Q&A. To me, that's sort of been the biggest boon to the E&M service coding, because it's so easy to do, requires so little documentation, and applies to so many of our patients, not just the most seriously ill of them, but just people with chronic care needs that you're gonna be their primary point of taking care of, their IBS, their GERD, their functional dyspepsia, whatever it is. If you're planning follow-up on the patient, that G2211 code is applicable to you. So don't forget about it. Get it incorporated into your practice, put it up there in the favorites on the billing. So again, the references for how to find some of these things are here, just as they were in Ed's E&M talk, and I'll stop at this point. I believe we're about to do a break, is that correct? Or Ed, you have other ideas? We are. We wanna give our audience as much value as possible, so I'm just gonna jump into one Q&A question, and then we'll break. Let's talk about treatment of lesions that are not actively bleeding. It's my understanding that if you find ABMs, they're not actively bleeding on an EGD. It's been my practice when I treat them to bill 43235. If I see active bleeding, I'll drop 43255 for those cases. In colonoscopy specifically, if I see active bleeding, I'll drop the control of bleeding code 45382. But if I see AVMs that are not actively bleeding, and I don't think that they contributed to the bleeding, then I'll use 45388. The caveat here is if I'm doing a colonoscopy for acute blood loss anemia, I find a large AVM in the cecum, it's not actively bleeding, but I'm suspicious that this was the cause of the bleeding, and there's an overlying clot, I will use the control of bleeding code when I treat it. Yeah. Yep, so to me, it's ablation when you're treating these lesions that are not bleeding, but you think they're clinically valuable to treat, and it's control of bleeding when they're obviously bleeding or has pretty clearly quite recently bled. The clinical context is like an acute or subacute bleed. Then you find a lesion, you're pretty sure it was responsible. You may be using ablation to treat that, but because it's an active bleed, you're using the control of bleeding code in that context. So I think that's how we've been traditionally handling the situation. Yeah, and control of bleed really says like any method. And also I would just note to the docs out there, just make sure when those, like if they're not like obviously actively bleeding out right now, but that was like stigmata of recent bleed or visible blood vessel, those terms help us to make sure that we build that control of bleed over that ablation as well. Yep, yeah, and if they don't have those stigmata, I mean, you can just state this seems clearly to have been the cause of recent bleeding and therefore applied a clip or did something. Yeah, again, that should be plenty of substantiation that you did a control of bleeding service rather than an ablation service. Now, if you see an AVM and don't do anything to it, then it doesn't count. It's just something you saw along the way and you might be coded for ICD-10 purposes, but it's not gonna change your CPT code. Just like when you see diverticular or you see internal hemorrhoids and they're there, but you're not doing anything to them. They're not clinically important as the reason for the procedure.

gastroenterology billing

E&M coding

transitional care management

Medicare reimbursements

revenue sources

chronic care management

telephone service billing

coding best practices