2027 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2026-You Asked, ASGE Answers- Top 10 Coding Questions for 2026

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The presentation reviews ten common 2026 gastroenterology coding questions:

1. <strong>Colonoscopic decompression:</strong> Documentation should support therapeutic decompression, not just report a successful result. Describing the technique is recommended, and clarification may be needed before billing CPT 45393.
2. <strong>Split/shared E/M services:</strong> When the physician meets the substantive-portion requirements, documentation from both the physician and APP may be used to determine the MDM level.
3. <strong>Combined hiatal hernia repair and TIF:</strong> The response treats the case as cosurgery under CPT 43281. Each physician should document their role and identify the other surgeon; payer authorization should be checked.
4. <strong>Biliary imaging interpretation:</strong> Documentation should identify the ducts injected and visualized and describe the images. Avoid conflicting interpretations by another provider.
5. <strong>Same-day E/M and elastography:</strong> A CMS payment reduction is described as taking effect January 1, 2027, with the additional service paid at 80%. The E/M must be separately identifiable and medically necessary.
6. <strong>Telehealth:</strong> Use POS 10 when the patient is at home and POS 02 for other locations. Verify and document the patient’s location, consent, and modality; providers must meet licensing rules where the patient is located.
7. <strong>IBD complications:</strong> Do not assume symptoms or findings are related to IBD without documentation. Use applicable “with” codes when supported and query the provider if the relationship is unclear.
8. <strong>Pathology materials:</strong> The response directs coding special stains using the appropriate CPT code in the 88312–88319 range.
9. <strong>Modifier 51:</strong> Under the cited BCBS policy, modifier 51 may apply to multiple lower-valued procedures; modifier 59 or XS may also be needed for distinct services.
10. <strong>Services during a global period:</strong> Use modifier 24 for an unrelated E/M service and modifier 79 for an unrelated procedure by the same physician.

Asset Subtitle

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

Meta Tag

Concept Therapeutic Decompressive Colonoscopy

Concept Split/shared E/M Visit

Concept Transoral Incisionless Fundoplication

Concept Fluoroscopic Bile Duct Imaging

Concept Telehealth

Keywords

gastroenterology coding

CPT 45393

split/shared E/M

hiatal hernia repair

TIF procedure

telehealth POS 10

IBD complications

pathology special stains

modifier 51

global period modifiers

Therapeutic Decompressive Colonoscopy

Split/shared E/M Visit

Transoral Incisionless Fundoplication

Fluoroscopic Bile Duct Imaging

Telehealth