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OasisLMS
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2025 Gastroenterology Reimbursement and Coding Upd ...
Top Denials in GI and How to Avoid Them
Top Denials in GI and How to Avoid Them
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Video Transcription
Video Summary
The presentation addresses common gastrointestinal (GI) claim denials and strategies to minimize them. Denials often result from billing and coding errors that aren't captured by electronic health records (EHRs) or claims scrubbers. Key errors include incorrect use of modifiers, inadequate documentation of procedures, misunderstanding bundling rules, and place of service inaccuracies. It's essential to document specifics like lesion size, location, and removal method while billing. Modifiers like 59 or XS help when performing multiple services. For example, in different lesion areas, providers should understand National Correct Coding Initiative (CCI) edits rules to avoid issues. Errors in medical necessity, specificity, and incorrect diagnosis codes can also lead to denials. Practices should reference local coverage determinations (LCDs) and engage patients in the appeal process. Consistent documentation, accurate coding, and understanding payers’ policies are crucial for reducing denials and ensuring timely claim payments.
Asset Subtitle
Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM
Keywords
GI claim denials
billing errors
coding strategies
EHR limitations
documentation importance
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