2026 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2025-Top 10 2025 Coding Questions/Issues received by ASGE

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This document presents the top 10 coding questions anticipated for 2025, answered by Kathleen Mueller, an expert certified medical coder and consultant. The questions address practical, billing, and procedural coding issues encountered in ambulatory surgery centers (ASCs) and practices dealing with various medical specialties.<br /><br />1. EMR coding requires documentation of lesion size, location, and removal methods; no specific polyp size is mandated.<br />2. Infusion services require the supervising physician's direct supervision in the same office suite; remote sign-off or absence during infusion is improper and may be considered false claims.<br />3. For unlisted small intestine procedures (CPT 44799), 43840 (gastrorrhaphy) is recommended as a comparable code.<br />4. Pathology services billing date depends on the payer; CMS requires billing at date of interpretation, but others may want the specimen collection date.<br />5. Colon cancer screening age guidelines have evolved; screening is individualized for ages 76-85 depending on health and history.<br />6. Conscious sedation can be billed separately at ASCs (code G0500) when providers monitor it, distinct from monitored anesthesia care.<br />7. Missed colonoscopy recalls for patients with history of polyps generally remain surveillance, not screening, based on factors like polyp type, size, and timing.<br />8. Medicare limits pathology CPT code 88305 billing to 16 units unless justified; claims exceeding this may be denied.<br />9. Control of bleeding during endoscopy is bundled in surgical codes; a 59 modifier applies only for bleeding control on separate lesions, and accurate diagnosis coding is critical.<br />10. Diagnostic colonoscopy has no frequency limits; screening colonoscopy for average risk begins at 45, with completeness defined as reaching the cecum (no modifier needed).<br /><br />Overall, the guidance emphasizes accurate, payer-specific documentation and adherence to supervision and billing protocols to ensure compliance and reimbursement.

Asset Subtitle

Kathleen A. Mueller, RN, CPC, CGCS, CCS-P, CMSCS, PCS, CCC

Keywords

EMR coding

infusion services supervision

unlisted small intestine procedure CPT

pathology billing date

colon cancer screening guidelines

conscious sedation billing

colonoscopy surveillance vs screening

Medicare pathology CPT code limits

endoscopy bleeding control coding

diagnostic colonoscopy frequency