ASGE Annual GI Advanced Practice Provider Course (Virtual) - Onboarding (Day One)

Pdf Summary

This document discusses various aspects of billing and coding in healthcare. It begins with a polling question about the most common follow-up visit office code billed in gastroenterology. Then, it provides objectives for the content, including an overview of the revenue cycle, differentiating between ICD-10CM, CPT, and HCPCS codes, reviewing EM coding guidelines, defining medical necessity, and capturing accurate data.<br /><br />The document highlights the rationale for coding specificity, stating that it helps represent and communicate the clinical scenario accurately. It also mentions that ICD-10 diagnosis coding can potentially enhance population health management and supports reimbursement strategies for risk-adjusted insurance plans.<br /><br />The revenue cycle section explains that coding systems are languages used to translate services performed and expected payment. It mentions AMA/CPT codes and HCPCS codes as examples. It also includes specific codes for gastroenterology procedures.<br /><br />The document explains the importance of coding to the highest specificity and provides examples of diagnosis codes in different chapters of the ICD-10CM tabular list.<br /><br />It further discusses evaluation and management (E/M) codes for new and established patient visits and consultation codes. It explains how to define the extent of work based on history, physical examination, and complexity of decision-making.<br /><br />The coding guidelines section includes information about the 1995/1997 guidelines and the changes in the 2021 guidelines. It also explains coding based on total time and provides examples of non-face-to-face and face-to-face activities that can be included in the documentation.<br /><br />Key coding elements, social determinants of health codes, payor options, revenue cycle, and the importance of medical decision-making and documentation improvement are also covered in the document.<br /><br />It ends with practice pearls, which suggest developing visual cues, templates, and workflows to optimize coding and documentation, as well as performing audits and clinical documentation reviews.

Asset Subtitle

Jill Olmstead, DNPc, ANP-BC, CCS-P, FAANP

Keywords

billing

coding

healthcare

gastroenterology

revenue cycle

ICD-10CM

CPT

HCPCS codes

E/M codes

documentation improvement