2027 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2026-The Other E and M We Do But Commonly Forget to Bill For

Pdf Summary

The presentation highlights underused evaluation and management (E/M) services and other billable care that gastroenterology practices may overlook, especially as Medicare reimbursement declines. It encourages clinicians to document medical decision-making accurately: follow-up patients who have not reached individualized treatment goals may not be “stable,” and appropriate Level 4 or 5 coding can materially affect revenue. Practices should also review their coding patterns and audit exposure.<br /><br />Potentially overlooked services include nurse visits (99211), transitional care management, chronic and principal care management, remote monitoring, home-health certification, care-plan oversight, tobacco-cessation counseling, portal-based digital E/M, virtual check-ins, image review, and provider-to-provider e-consultations. The presentation emphasizes that each service has specific eligibility, timing, consent, documentation, and billing rules. For example, digital E/M generally requires an established patient’s initiated communication and cumulative time documentation; virtual check-ins have separate restrictions; and e-consultations require a documented provider request.<br /><br />It also discusses newer or changing payment rules, including the G2211-related B1/B2 modifiers and reductions when modifier 25 applies. Practices should verify payer-specific policies, since Medicare and commercial coverage may differ. Separate visits for longitudinal care and minor procedures may sometimes be appropriate when clinically justified.<br /><br />Finally, practices may consider additional cash-pay services, such as nutrition or obesity management, while ensuring applicable billing and coverage requirements are followed. The overall message is to establish reliable workflows, train staff and billers, document services clearly, and check current CMS and payer guidance before billing.

Asset Subtitle

Glenn D. Littenberg, MD, MACP, MASGE

Meta Tag

Concept Gastroenterology Evaluation and Management

Concept Office Visit

Concept Chronic Care Management

Concept Principal Care Management

Concept Transitional Care Management

Keywords

gastroenterology

evaluation and management

Medicare reimbursement

medical decision-making

coding audit

transitional care management

chronic care management

remote monitoring

virtual check-ins

billable services

Gastroenterology Evaluation and Management

Office Visit

Chronic Care Management

Principal Care Management

Transitional Care Management