Gastroenterology billing and coding practice challenges are unique. Gastroenterology billing can be complex because this field requires medical and surgical aspects. It necessitates a thorough understanding of gastroenterology CPT codes. Gastroenterology billing includes the codes and procedures for billing insurance companies for a patient’s gastroenterology procedure. Accurate medical coding guarantees that insurers have the diagnostic codes for proper payment. Appropriate coding is also essential for demographic evaluations, disease prevalence studies, treatment outcomes, and accountability-based reimbursement frameworks.
Managing successful gastroenterology practice can be difficult; while focusing on providing the best possible patient care, you must ensure that your practice is financially sound. Numerous factors influence the bottom line, but your gastroenterology billing reflects the most significant opportunity for success—or, conversely, failure if not correctly handled. Gastroenterology billing services are demanding, and working with billing experts can assist you in achieving financial goals.
Common Gastroenterology Billing Issues
As with almost any specialty billing system, there will undoubtedly be difficulties that you and your staff will face along the way. Some of the gastroenterology billing difficulties may include:
Failure To Ensure Proper Documentation
Proper documentation is required for correct code assignment and demonstrating the medical necessity for successful billing, particularly for Medicare. Failure to establish a medical condition can result in denied claims and authorization denials for lab tests, medication, diagnostic studies, and other services. Medicare and commercial payers typically use local coverage determinations (LCDs) for specific procedures and testing, including indications, restrictions, and authorized diagnosis codes. Without appropriate documentation, delayed revenue becomes lost revenue because claims are automatically rejected. Clear documentation is critical as data transparency grows and more payers require proof of medical reason.
Improper Modifier Usage
Another popular GI coding error is the incorrect use of modifiers. When modifiers 51 and 59 are commonly mixed up, it results in rejected claims. Modifier 51 Multiple Procedure should be used when two procedures in two different coding categories are performed on the same day. Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same service date. Professionals in gastroenterology billing must be well-versed in GI function studies, category III codes for GERD treatment, and the use of modifiers -51, -59, and -26, among other things. Because coding for gastroenterology is time-consuming, it requires a high level of comprehension and knowledge to ensure maximum reimbursement.
Failing To Keep Up With CPT Updates
The American Medical Association updates the Current Procedural Terminology (CPT®) code. Keeping up with ever-changing medical billing regulations, CPT® code changes, ICD-10 code changes, and handling denied and rejected claims is frustrating and time-consuming. Keeping up to date on changes is critical for avoiding costly denials.
Outdated Patient Information
One of the difficulties that any medical practice faces is a lack of access to their patients’ most recent insurance information. There are several reasons for the billing change; however, the most important is that your administrative team contacts the correct and current insurance company. Taking the initiative to double-check insurance details before providing services can save your practice immense time.
CPT Codes For Common Gastroenterology Practice
There are nearly 72,000 ICD-10-CM codes. It gets challenging to select and find the exact code when searching in the electronic health record and billing system. Personnel education and training are critical to navigating codes for making your practice’s billing industry as efficient as possible.
Here are some standard gastroenterology CPT codes:
|Serial Number||Types of Diseases||Codes|
|1||Diarrhea||K52.2, K52.89, R19.7|
|2||Abdominal Pain||R10.10, R10.2, R10.30|
|3||Benign Neo Rectum/Anus||D12.7, D12.8, D12.9|
|4||Flatulence Eructation/Gas||R14.0, R14.1, R14.2, R14.3|
|5||Benign Neo Lg Bowel||D12.0, D12.1,D12.6, K63.5|
|6||Crohn’s Disease||K50.10, K50.111, K50.112, K50.113, K50.114, K50.118, K50.119|
|7||Disorders of gallbladder||K82.A1, K82.A2|
|8||Acute appendicitis with generalized peritonitis||K35.20, K35.21|
|9||Acute appendicitis with generalized peritonitis||K35.30, K35.31, K35.32, K35.33|
|10||Ischiorectal abscesses||K61.31, K61.39|
Tips to Overcome Gastroenterology Billing Issues
The following are the most effective tips to overcome gastroenterology billing issues.
Make Use of the Appropriate Billing Codes
ICD-10 codes support medical requirements for the services provided. While physicians must document the most particular clinical diagnosis, medical coders should assign diagnosis codes based on the highest level of specificity. This is critical for proper claim processing and reimbursement.
For example, Take note of the distinction between diagnostic and screening colonoscopies. Following ICD-10 codes can be used to notify screening colonoscopies:
010 – Personal history of colonic polyps
11 – Malignant neoplasm screening of the colon
0 – There is no family history of malignant neoplasm of the digestive organs
Recognize That Billing Requires Collaboration
The doctor is in charge of providing accurate and specific paperwork and returning charges to the billing staff for claim submission. Billing staff must notify physicians or providers of any significant changes as they occur. To ensure everything is submitted correctly under payer policies, physicians and coding staff must maintain an open line of communication.
Improve Diagnostic Study Language
Medical requirements for testing must be recorded to submit charges for diagnostic studies. Words like “rule out” or “suspect” don’t fully explain to coders why a physician suspects the patient – unusual lab tests, signs, and symptoms frequently justify the requirement for additional investigation, which are the most important indications for testing. Verify that the explanation of the test results is clear, as well as a plan or recommendation for the next steps.
Appropriate Billing For Evaluation And Management (E&M) Services
The initial measures for patients at any gastroenterological practice are evaluation and management services. To support any initial appointment with patients following three criteria must be met:
- Conducted examination
- The advancement of the treatment plan
There are five service levels for office visits and three for inpatient visits, so choose the correct one while billing.
Choosing The Best Gastroenterology Billing Services For Your Practice
Once you’ve decided to use a third-party billing provider for billing services, you must select the best gastroenterology billing solution provider. Not all billing companies are of the same capacity, and while no vendor or system is “perfect,” some are better suited to your practice needs than others.
Outsourcing your gastroenterology billing and coding to a reputable company with knowledgeable, certified professionals can assist your practice in ensuring clean claim submission to decrease denials and maximize revenue. Our gastroenterology billing services can provide your practice with the medical billing knowledge required to grow and prosper in today’s modern medical environment. We have successfully delivered our full-stack quality services to gastroenterology practices and handled collections across the United States. Some of our billing services benefits include:
A Committed Billing Team: We have billing specialists who monitor and supervise your claims from start to end. They ensure that you get paid what you’re owed.
Robust technology: We have a powerful practice management platform with tools and features to help optimize the billing, collections, and payment processes—our rejection analysis and management assist organizations in receiving reimbursements on time.
Claim Submission: We have the best claim submission process in which claims are created, “scrubbed,” and rapidly submitted to payers. We have gastroenterology billing professionals who can determine why a claim was rejected and make the necessary corrections and modifications to resubmit the claim.
Management Of Denials and Rejections: Our experts can handle rework for denials and rejection appeals to obtain payment. We understand the claims denial procedure and can quickly and effectively appeal denied claims to ensure prompt reimbursement.
Reporting In Great Detail: Our team completes real-time reports that give you access and transparency into your billing achievement.
Contact our billing specialists today to learn more about what I-Med Claims can do for your gastroenterology billing and revenue cycle management!