2026 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2025-Best Practices in Coding for Ancillary Services: Anesthesia, Pathology, Infusions and Diagnostic Studies

Video Transcription

Video Summary

The detailed presentation covers key compliance and billing considerations for anesthesia, pathology, diagnostic, and infusion services primarily in gastroenterology practices. <br /><br />For anesthesia services, medical necessity must be clearly documented by the anesthesia provider. Medicare policies, especially for Monitoring Anesthesia Care (MAC), outline specific approved diagnoses and require detailed documentation including patient status, anesthesia type, procedure start/end times, and provider signatures. Codes vary by procedure type, with modifiers like QZ (payment) and QS (informational) being important for CRNA involvement. Screening and diagnostic coding nuances impact patient cost-sharing.<br /><br />Pathology services require clear documentation of specimen details, clinical history, diagnosis codes linked to specimens, and signed pathology reports. Stains and immunostains need medical necessity justification, and payers may require separate line items or modifiers. Providers must ensure pathology requisitions include clear indications to avoid denials.<br /><br />Diagnostic studies like manometry, pH, elastography, and capsule endoscopy have specific billing rules; global or technical/professional splits require appropriate modifiers and timely interpretation and reporting.<br /><br />Infusion services demand stringent documentation: current orders, provider supervision levels, start/stop times, dosage, and patient response. The referring provider must be from the ordering GI practice, not primary care. Medicare limits infusion payment to office settings; codes and modifiers (e.g., JW for waste, JA for infusion specifics) must be correctly applied. Practices should maintain payer-specific spreadsheets to track nuances and ensure compliance.

Asset Subtitle

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

Keywords

anesthesia services

billing compliance

pathology documentation

diagnostic coding

infusion services

gastroenterology practices

Medicare policies

procedure modifiers