2026 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2025-Examples for both Medical Decision Making and Time Driven Visits

Video Transcription

Video Summary

The presentation focuses on proper documentation for Evaluation and Management (E&M) services, bridging the perspectives of healthcare providers and auditors, especially regarding gastroenterology cases. Emphasis is placed on clearly documenting medical decision-making elements—problems addressed, data reviewed, and risk—to justify accurate billing levels. Clinical examples illustrate how chronic conditions with exacerbations, diagnostic tests, and procedure risks affect service level assignment from moderate to high complexity.<br /><br />Key points include: detailing specific assessments and plans rather than vague statements; incorporating patient-specific risk factors (e.g., anticoagulation, comorbidities) especially for endoscopic procedures; and explaining emergent or urgent conditions to support higher billing levels. Time-based billing is addressed, highlighting the necessity to document total time spent on patient care, including chart review and discussions, with explicit time components to justify levels when decision-making alone is insufficient.<br /><br />The speaker provides practical tips: always use lay terminology, integrate history details into assessment, and document conversations with other providers and external records reviewed. Examples show that specialists rarely bill low-level visits; thorough documentation supports appropriate coding from levels 3 to 5. Strong documentation of risks and data, alongside clear clinical reasoning, is essential for compliance and reimbursement integrity in GI patient care.

Asset Subtitle

Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Meta Tag

Concept Evaluation and Management Coding

Concept Medical Decision Making

Concept Problems Addressed

Concept Data

Concept Risk

Keywords

Evaluation and Management documentation

medical decision-making

gastroenterology billing

risk assessment in E&M

time-based billing

clinical documentation tips

compliance in GI patient care

Evaluation and Management Coding

Medical Decision Making

Problems Addressed

Data

Risk