ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day One)

Pdf Summary

The document is a slide-based overview of billing and coding updates for gastroenterology, focused on how accurate documentation and code selection affect reimbursement, data quality, and compliance. It opens with polling questions emphasizing that the most common established follow-up office visit code in GI is typically 99214, and that Medical Decision-Making (MDM)—not history or physical exam—drives the E/M service level under current guidelines.<br /><br />Key objectives include explaining the revenue cycle, distinguishing ICD-10-CM (diagnoses) from CPT (procedures/services) and HCPCS (additional Medicare/administrative codes), reviewing E/M rules, defining medical necessity, and highlighting the importance of capturing accurate, specific clinical data. The presentation stresses ICD-10 specificity (e.g., IBS subtype codes, atrial fibrillation type, anticoagulant use, obesity class and BMI Z codes) and coding all conditions that influence clinical decision-making. It also reviews ICD-10 chapter structure and highlights Chapter 21 Z codes, especially Social Determinants of Health (SDOH) documentation (housing instability, food insecurity, transportation barriers, social isolation, environmental exposures), tying SDOH to risk, outcomes, and potential care limitations.<br /><br />For E/M coding, the content summarizes new vs. established visit ranges and explains MDM elements: (1) problems addressed, (2) data reviewed/analyzed, and (3) risk of complications/morbidity/mortality—requiring 2 of 3 elements to meet a level. It provides a matrix connecting MDM levels to CPT codes (99202–99205; 99212–99215). It also outlines 2025 time thresholds for time-based coding and defines “total time” on the encounter date, including certain non-face-to-face work.<br /><br />Telehealth updates include new synchronous audio-video and audio-only E/M CPT code ranges, replacing deleted telephone codes (99441–99443), with time/MDM-aligned descriptors. The HCPCS add-on code G2211 is discussed as a visit complexity add-on for ongoing care, with updated CMS guidance for 2025 (including use alongside modifier 25 in some cases).<br /><br />The presentation closes with payer considerations (Medicare/MA, Medicaid, commercial plans), prior authorization and denial risks, and practice tips such as templates, workflow improvements, audits, and peer documentation review to support medical necessity and accurate reimbursement.

Asset Subtitle

Jill Olmstead, DNP, ANP-BC, FAANP

Keywords

Gastroenterology billing and coding updates

E/M coding guidelines MDM-based leveling

CPT 99202-99205 99212-99215 office visit codes

ICD-10-CM diagnosis specificity (IBS subtype, AFib type, BMI/obesity)

Medical necessity documentation and reimbursement compliance

Social Determinants of Health (SDOH) Z codes Chapter 21

2025 time-based E/M coding total time thresholds

Telehealth E/M synchronous audio-video and audio-only CPT codes

HCPCS G2211 visit complexity add-on code CMS 2025 guidance

Revenue cycle management prior authorization denials audits