2026 Gastroenterology Reimbursement and Coding Update (On-Demand) | November 2025-Proper Documentation for Advanced Endoscopy: Reimbursement Tips when Billing Unlisted Procedure Codes

Proper Documentation for Advanced Endoscopy: Reimbursement Tips when Billing Unlisted Procedure Codes

Video Transcription

Video Summary

This detailed presentation addresses documentation and reimbursement challenges for advanced endoscopy procedures such as EUS, EMR, ESD, necrosectomy, endoscopic gastrocutaneous fistula closure, EDGE/GATE procedures, POM/G-POM, TIFF, and optical endomicroscopy. Key points include updated coding guidelines—for example, EUS codes require explicit documentation of examining all three areas of the upper GI tract to bill comprehensively. EMR billing demands clear descriptions of demarcation borders and therapeutic steps, with awareness that some payers exclude EMR from screening colonoscopy coverage. Unlisted procedure codes are common for submucosal dissection, necrosectomy, fistula closures, and novel procedures like EDGE, requiring detailed cover letters justifying complexity and necessity. Coordination between providers is critical for co-surgeries like TIFF. Thorough documentation, including indications, instruments used, complexity, and visual aids, is vital to facilitate payer understanding and approval. The use of appropriate modifiers, diagnosis codes, and detailed notes in claim forms is emphasized to prevent denials and support reimbursement.

Asset Subtitle

Kathleen A. Mueller, RN, CPC, QMC, QGMC, CCS-P, ICD-10 Proficient

Keywords

advanced endoscopy

EUS coding guidelines

EMR documentation

unlisted procedure codes

reimbursement challenges

procedure coordination