2026 Gastroenterology Reimbursement and Coding Update (Virtual)

Video Transcription

Video Summary

The Q&A session addressed complex issues in GI procedures, focusing on billing, coding, and coverage challenges. Key topics included distinctions between screening and diagnostic colonoscopies, particularly in open access programs where billing for pre-procedure history and physical exams is limited unless unrelated conditions are addressed. Managing unexpected patient histories during screening—such as undetected prior polyps—requires transparent communication about surveillance versus screening classifications. Coding nuances for incomplete colonoscopies due to poor prep were discussed, emphasizing adherence to payer guidelines and patient instruction importance. EMR coding complexities arose, especially for techniques like underwater EMR and billing during screening colonoscopies, with noted insurer denials prompting appeals and advocacy for updated policies. Endoscopic ultrasound coding dilemmas included bundling issues and unlisted codes for advanced procedures like gallbladder drainage and sponge placement. Capsule endoscopy prerequisites depend heavily on payer policies and clinical scenarios, with preauthorization and documentation crucial. Overall, the session underscored the evolving landscape of GI coding, reimbursement, and clinical best practices.

Keywords

GI procedures billing

screening vs diagnostic colonoscopy

EMR coding complexities

endoscopic ultrasound coding

capsule endoscopy preauthorization

GI coding reimbursement challenges