2026 Gastroenterology Reimbursement and Coding Update (Virtual)

Video Transcription

Video Summary

The discussion covers coding and billing nuances in gastroenterology care, focusing on G2211 for managing serious conditions during initial and follow-up office visits by providers within the same practice, with no billing limits or frequency restrictions. Post-procedure visits, like after a colonoscopy, are billable if there's a clinical reason to discuss findings or ongoing care, with G2211 applicable for longitudinal management. Time-based billing requires documenting total time spent on care activities without mandating detailed time breakdowns, and only the attending physician's time counts for billing. Social determinants of health coding (SDOH) helps characterize patient risk and impacts reimbursement. Modifier 25 is scrutinized heavily; billing an office visit with a procedure requires clear, distinct documentation beyond the procedure itself. Separate billing for office and hospital visits by the same provider under one tax ID is usually not allowed, except for critical care services. Risk levels for procedures depend on patient factors, not anesthesia presence. Taxonomy coding affects billing for subspecialties like transplant hepatology.

Keywords

G2211 billing code

gastroenterology coding

post-procedure visit billing

time-based billing documentation

social determinants of health coding

modifier 25 scrutiny