4 Key Elements of GI Billing

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4 Key Elements of GI Billing

• Effective billing practices are crucial in
  gastroenterology practices to ensure accurate
  reimbursement and successful claim submission.
  This article explores the four key elements of GI
  billing Evaluation and Management (EM)
  services, endoscopy and procedural billing,
  diagnostic studies, and diagnosis codes.
  Understanding these elements is essential for
  providers, coding staff, and billing teams to
  navigate the complexities of medical necessity
  documentation, code assignment, and claim
  submission. By emphasizing the importance of each
  element and highlighting the challenges involved,
  this article aims to promote knowledge and
  collaboration within GI practices to optimize
  billing processes and financial outcomes.
• 4 Key Elements of GI Billing
• Gastroenterologists perform and interpret four
  primary services
• 1. Evaluation and Management (EM) Services
• For any initial visit with patients, there are
  three essential criteria to meet obtaining
  patient history, performing an examination, and
  developing a treatment plan. Office visits have
  five levels of service, while inpatient visits
  have three levels. The selection of the
  appropriate level of service relies on the
  decision-making aspect of the visit, considering
  that the documentation requirements are
  fulfilled. However, choosing

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4 Key Elements of GI Billing
the correct level can be challenging without a
proper understanding of EM criteria. It is not
uncommon for auditors to observe visits being
determined through guesswork, resulting in the
selection of a lower or higher level than what
was actually provided. Some providers may
underestimate the importance of EM services,
considering procedures as the primary revenue
source. Nevertheless, in GI practices, visits
play a significant role, and initial visits often
carry more RVUs than certain procedures. The EM
visit is crucial, serving as the foundation for
establishing medical necessity for additional
procedures and diagnostic services necessary for
effective patient treatment. 2. Endoscopy
Procedural Billing In endoscopy and procedural
billing, it is crucial to document medical
necessity to facilitate the submission of
charges. Gastroenterologists often employ
multiple techniques when treating various areas
of the gastrointestinal tract. Documentation
should include details such as the location of
lesions/abnormalities, the method of
treatment/removal, and the reasons/indications
for the procedures. In the colon, different
instruments may be used for different areas
(e.g., snare in the sigmoid colon, biopsy forceps
in the transverse colon). These services can be
reported separately with appropriate modifiers to
indicate that they were performed on distinct
lesions/abnormalities.
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4 Key Elements of GI Billing
However, to bill for each procedure, all relevant
information must be documented in the endoscopy
report. The responsibility lies with the
physician to ensure accurate and specific
documentation and to relay the charges to the
billing staff for claim submission. A team
approach is vital for a successful practice,
necessitating open communication between
physicians and coding staff to ensure proper
submission according to payer policies. The
billing staff should promptly inform
physicians/providers of any significant changes
as they occur. It is important to note that
ignorance of payer policies is not considered an
acceptable excuse when payers investigate claims
and potential recoupment of funds paid. 3.
Diagnostic Studies In diagnostic studies, it is
essential to document the medical necessity and
indications for testing to facilitate the
submission of charges. Using terms like rule
out or suspect alone does not provide coders
with sufficient information about the physicians
reasoning behind suspecting a specific condition.
Typically, abnormal lab tests, signs, and
symptoms justify the need for further
investigation, making them crucial indications
for testing. This importance extends not only to
diagnostic studies but also to procedures. It is
crucial to ensure that the interpretation of test
results is clear and accompanied by a
well-defined plan or recommendation(s). Clear
documentation in these areas helps support the
medical necessity of the tests and procedures
performed.
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4 Key Elements of GI Billing
4. Diagnosis Codes After a visit, diagnostic
study, or procedure, the next crucial step is
assigning codes according to the International
Classification of Diseases, 10th revision,
Clinical Modification (ICD-10-CM). These codes
play a significant role in supporting the medical
necessity of the services provided, and the
specificity of the diagnosis code is essential
for successful claim submission and payment. When
ruling out more significant diseases or
diagnoses, signs and symptoms can be valid code
choices as they justify the need for a work-up to
determine the underlying cause. Additionally,
comorbidities that impact the providers
decision-making should be included as additional
diagnoses to support a higher level of
decision-making. Up to 12 diagnosis codes can be
assigned to any type of service. This also
applies to obtaining preauthorization for
services such as lab tests, radiology studies, GI
diagnostic studies, and procedures. It is crucial
to ensure that specific information is
documented, as payers often deny certain lab and
radiology studies, as well as certain procedures,
if the necessary information is missing. With a
vast selection of 71,932 ICD-10-CM codes, finding
the specific code can be challenging within
electronic health records and billing systems.
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4 Key Elements of GI Billing
To summarize, the proper understanding and
application of Evaluation and Management (EM)
criteria, accurate documentation of endoscopy and
procedural details, clear indication and
interpretation of diagnostic studies, and precise
assignment of diagnosis codes are key elements of
GI billing. By focusing on these four key
elements, GI practices can enhance their revenue
cycle management, streamline operations, and
ultimately deliver quality care to their
patients. About Medical Billers and Coders
(MBC) Medical Billers and Coders (MBC) is a
trusted and reliable gastroenterology
billing company that specializes in providing
comprehensive billing services tailored to the
unique needs of gastroenterology practices. With
our expertise in medical coding, documentation
requirements, and billing regulations specific to
the field of gastroenterology, MBC ensures
accurate and efficient claim submission and
reimbursement. By partnering with MBC,
gastroenterology practices can rely on their
expertise and industry knowledge to streamline
their billing processes, increase efficiency, and
focus on delivering high-quality care to their
patients. For further information about
Gastroenterology billing services, please reach
out via email at info_at_medicalbillersandcoders.com 
or by calling 888-357-3226.