How MBC Can Help in Reducing Your Gastroenterology Billing Errors?

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How MBC Can Help in Reducing Your
Gastroenterology Billing Errors?
Challenges of Gastroenterology
Billing Gastroenterology billing and coding is
complex and challenging as Gastroenterologists
provide both medical and surgical services.
Accurate, efficient billing and coding for
Gastroenterology services ensure the survival of
practice amidst various challenges like the
COVID-19 pandemic. As per a recent
Gastroenterologist compensation report, 52
percent of self-employed gastroenterologists saw
a 1 to 25 percent decline in patient volume that
they consider permanent. Such stats highlight
the need of utilizing every rightful opportunity
to collect reimbursement for Gastroenterology
services. Due to the complex nature of
Gastroenterology billing, Revenue Cycle
Management (RCM) team tends to make billing
errors. Medical Billers and Coders (MBC) is a
leading medical billing company providing
complete medical billing services. We can help
you in reducing Gastroenterology billing errors
which would help you to collect more while
staying compliant with billing guidelines. Reduci
ng Your Gastroenterology Billing Errors
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How MBC Can Help in Reducing Your
Gastroenterology Billing Errors?
Appropriate Use of E/M Codes Evaluation and
management (E/M) codes are assigned based upon
two elements i.e., time and medical
decision-making (MDM). Due to changed guidelines
for evaluation and management codes, billers
often make mistakes while using Gastroenterology
E/M codes 99202-99215. Effective from the year
2021, the definition of time associated with
99202-99215 changed from typical face-to-face
time to total time spent on the day of the
encounter. Billers need to be careful while
using these E/M codes and keep in mind that the
aim of this change is to clarify times when more
than one provider is involved.  Appropriate Use
of Modifiers Modifiers indicate that a service
or procedure performed has been altered by some
specific circumstance, but not changed in its
definition or code. They are used to add
information or change the description of the
service to improve accuracy or specificity. In
some cases, inexperienced coders use modifiers to
receive increased insurance reimbursement. Such
billing practices are considered malpractices
leading to false billing and could result in
external payer audits or heavy penalties.
The gastroenterology billing team often confuses
between modifier 51 (i.e., multiple procedures)
and 59 (i.e., distinct procedural service).
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How MBC Can Help in Reducing Your
Gastroenterology Billing Errors?
Though both modifiers are used when multiple
services are performed they serve different
purposes. Modifier 51 is used to identify the
second and subsequent operative procedures to
third-party payers when the procedures are ranked
in order of RVU and are not added to the primary
procedure based on what was done to address the
patients illness. On the other hand, modifier 59
is used for the different sessions or encounters
on the same date of service different procedures
distinct from the first procedure, different
anatomic sites, and separate incisions, excision,
injury, or body part. Using Accurate Diagnosis
Codes Selected diagnosis (ICD-10) codes must
support medical necessity for the services
provided. While physicians need to document the
most specific clinical diagnosis, medical coders
should assign diagnosis codes to the highest
degree of specificity documented. Choosing
inaccurate diagnosis codes could lead to claim
rejections and might delay reimbursement. In a
situation where the Gastroenterologists cannot
establish a diagnosis for an encounter, the
condition or conditions such as symptoms, signs,
abnormal test results, or other reasons for the
visit, should be coded to the highest degree of
certainty. Comorbidities can be coded to support
a higher level of decision-making.
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How MBC Can Help in Reducing Your
Gastroenterology Billing Errors?
Ensure Proper Documentation Failure to
demonstrate medical necessity could lead to
denied claims and authorization denials for lab
tests, medication, diagnostic studies, etc.
Government payers like Medicare and private
payers have local coverage determinations (LCDs)
for many procedures and testing, including
indications and restrictions, along with approved
diagnosis codes. Documentation is an area where
most Gastroenterology billing team fails to prove
medical necessity or to justify procedure (CPT)
code selection. When it comes to billing
diagnostic studies and procedures, medical
necessity/indication for the testing must be
documented. Usually, abnormal lab tests, signs,
and symptoms are the most crucial red flags for
testing. Your documentation must include the
interpretation of the test results along with
recommendation(s). Common Gastroenterology
Billing Errors As mentioned earlier,
Gastroenterology billing and coding is complex
and challenging as Gastroenterologists provide
both medical and surgical services. Below we
listed some of the common Gastroenterology
billing errors and ways to avoid them
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How MBC Can Help in Reducing Your
Gastroenterology Billing Errors?

• Control of bleeding is included in endoscopic
  procedures and is not separately billable unless
  the patient comes in faculty with GI bleed. The
  control of bleeding by colonoscopy is coded with
  CPT code 45382. Append the -78 modifier to the
  CPT code for the return to the OR for control of
  bleeding procedures. The physician examines the
  colon and rectum using a colonoscope to identify
  the source of internal bleeding. He then controls
  the bleeding in the colon by various methods. CPT
  code 45382 is listed under Endoscopy Procedures
  on the Rectum.
• Incomplete or failed colonoscopies should be
  coded properly with G-Code with the -52 or -74
  modifier, Modifier indicates the discontinued
  procedure. You can refer to payer-specific coding
  guidelines for the correct use of modifiers.
• If during Esophagogastroduodenoscopy (EGD)
  procedure, a lesion is biopsied and subsequently
  removed during the same procedure, then you can
  only bill removal of the lesion. The biopsy will
  be considered an incidental procedure and should
  not be separately billable. If the lesion is
  removed using a different method during the same
  procedure, then you can code biopsy and lesion
  and removal of the separate lesion with the
  appropriate modifier (modifier -59).

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How MBC Can Help in Reducing Your
Gastroenterology Billing Errors?
Medical Billers and Coders (MBC) is well-versed
with gastroenterology billing and endoscopy
billing. Our team of Gastroenterology medical
billing and coding specialists works hand-in-hand
with your practice to ensure you receive accurate
reimbursement for delivered services. To know
more about our Gastroenterology billing and
coding services, contact us at 888-357-3226 or
drop an email at info_at_medicalbillersandcoders.com
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