Have you felt the frustrations of rejected claims due to inaccurate billing and coding? Gastroenterology billing includes many coding requirements that increase the complexity of the billing process. Along with that, labor shortage, skyrocketing wages, and increasing claim denials deteriorate the financial stability of your practice. It seems like a never-ending problem that creates frustration among providers.
According to the Medical Group Management Association survey, 65% of revenue loss due to erroneous coding of the procedures. Expert advisors from societies like- the American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and so on, regularly assess the CPT codes and modify them through the American Medical Association (AMA) process. In line with this commitment, we have discussed CPT code categories I and III to mitigate the pain points in Gastroenterology billing.
Category I CPT Codes in Gastroenterology Billing
The category provides clarification on the accurate selection of CPT codes and avoids unbundling revisions. According to AMA, the unbundling involves multiple CPT codes for the separate components of a procedure. Unlisted codes, such as 43499 (Unlisted operation, esophagus) or 45399 (Unlisted procedure, colon), should be used in situations where no specific code is available.
Revision of Office Visits and E/M Codes
The office visit codes 99202-99205, and 99212-99215 codes have been updated. The previous time range in minutes for each code has been removed.
Revision of Shared Visits
The clarity on split or shared visits has been considered by the recent modification of CPT codes. This is determined by the substantive amount of evaluation and management services rendered.
Category III CPT Codes in Gastroenterology Billing
- Code 0813T- indicates the adjustment of the gastric balloon. However, if you report this with 43197, 43198, 43235, 43241, 43247, 43290, and 43291, you will make a fatal mistake in Gastroenterology billing.
- Code 0868T indicates Gastric Electrophysiology Mapping. You cannot report this code in conjunction with 91132, 91133, 0, or 779T.
- Code 0884T- indicates an Endoscopic Drug Coated GI Balloon with esophagoscopy, colonoscopy, and flexible sigmoidoscopy. Never report this code in conjunction with 43191, 43195, 43196, 43200, 43213, 43214, 43220, 43226, 76000.
- Code 0885T- indicates flexible colonoscopy with first trans-endoscopic mechanical dilatation and therapeutic drug distribution by balloon catheter coated with medication for colonic stricture, with fluoroscopic supervision where necessary. You cannot report this code in conjunction with 45378, 45386, 76000, or 0886T.
- Code 0886T- indicates colonic stricture, flexible sigmoidoscopy with initial trans-endoscopic mechanical dilatation, and therapeutic medication distribution by a drug-coated balloon catheter, incorporating fluoroscopic guidance, as necessary. Do not report this code with 45300, 45303, 45330, 45340, 76000, or 0885T.
Apart from coding-specific challenges, payor guidelines for claim submission create another obstacle in effective Gastroenterology billing. There are over 900 health insurance providers in the US today and dealing with them can be confusing. Though not everybody operates in your area, there is a good chance that as a specialty provider, you are contracted with anywhere from 10 to 25 different payors. This may be where an outside organization can take care of your billing and coding services.
Final Thoughts
Considering today’s healthcare landscape, practices need to maximize the patient experience while capturing the revenue for rendered services. Balancing between quality care and the complex maze of Gastroenterology billing can be tough. Hence, partnering with an outsourced revenue cycle management organization can be helpful. These companies have a dedicated team for coding and billing services with detailed knowledge and understanding of billing guidelines. They can strengthen your operations and help you generate optimized revenue for your practice in the long run.
Sunknowledge Services Inc. – an ISO 27001:2022 certified, American-owned & operated company, headquartered in New York City – is a leading global provider of Business and Knowledge Process Outsourcing services in the US healthcare domain.
