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Gastroenterology Billing Challenges and New Changes for 2019

October 18, 2018

Gastroenterology BillingGastroenterology billing and coding is both complex and challenging, and perhaps nothing else has such a huge impact on your revenue cycle. Accurate, efficient billing and coding can accelerate your billing cycle and increase revenues, while mistakes in this area can result in lost revenues due to paybacks, denials, and under-coding. Here’s a closer look at some of the most GI billing and coding mistakes, important tips to follow to prevent mistakes and improve revenue, and new changes coming for the specialty in 2019. 

Common GI Billing and Coding Mistakes 

The first step to preventing the loss of revenue due to billing and coding mistakes recognize the most common mistakes and how your gastroenterology practices can prevent them. 

  • Mistake #1 – Documentation Gaps– One of the biggest mistakes that can lead to undercoding or even claims denials is gaps in documentation. Failing to capture essential data at any point in the clinical documentation and coding continuum can leave you with rejected claims because there isn’t the documentation to support those claims. Without proper documentation, delayed revenues turn into lost revenues because claims are outright rejected. As data transparency continues to grow and more payers want to see proof of medical necessity, clear documentation is crucial. 
  • Mistake #2 – Improper Use of Modifiers– Another common GI coding mistake is the improper use of modifiers. Modifiers 51 and 59 are often confused, resulting in rejected claims. Modifier 51 should be used for two procedures that are in two different coding categories that are being done on the same day. You should use modifier 59 when a different site is addressed or a different procedure is done on the same day that normally wouldn’t be one. 
  • Mistake #3 – Failing to Keep Up with CPT Updates– Every year the CPT code set changes just a bit, and many of these changes affect gastroenterology practices. Old codes may be removed, the application of codes may change, and codes are added. Staying current on updates is essential to preventing costly denials.

Important Tips for GI Billing and Coding 

A few specific GI billing and coding tips to remember to reduce the chance of costly denials include: 

  • Remember that control of bleeding generally isn’t billed separately. Most endoscopic procedures include the control of bleeding. It cannot be billed separately unless the patient comes in with a GI bleed and it’s the main reason an endoscopy is performed. 
  • Understand that there’s a difference between diagnostic and screening colonoscopies. Screening colonoscopies can be reported with these ICD-10 codes:
    • 11 – screening for malignant neoplasm of colon
    • 010 – personal history of colonic polyps
    • 0 – family history of malignant neoplasm of the digestive organs 
  • Medicare Rules for Screening Procedures – Medicare requires a separate modifier for a situation in which polyps are found and then removed during screening colonoscopies. The correct CPT must be used with the modifier PT. 

New GI Billing and Coding Changes for 2019

For 2019, 473 ICD-10 changes are being made, including 279 brand new codes and 51 deleted codes. The main theme surrounding new codes, revised codes, and deleted codes is increased specificity, and these codes will begin to apply to coding starting on October 1, 2018. Some of the new GI billing and coding changes for 2019 include: 

  • Acute appendicitis with generalized peritonitis (changes for greater specificity)
    • K35.20 – Acute appendicitis with generalized peritonitis, without an abscess
    • K35.21 – Acute appendicitis with generalized peritonitis, with an abscess 
  • Acute appendicitis with localized peritonitis (changes for greater specificity) 
    • K35.30 – Acute appendicitis with localized peritonitis, without gangrene or perforation
    • K35.31 – Acute appendicitis with localized peritonitis and gangrene, without any perforation 
    • K35.32 – Acute appendicitis with perforation and localized peritonitis, without an abscess
    • K35.33 – Acute appendicitis with perforation and localized peritonitis, with an abscess 
  • Ischiorectal abscesses (changes for greater specificity)
    • K61.31 – Horseshoe abscess
    • K61.39 – Other ischiorectal abscess 
  • K80 Cholelithiasis Series (some new instructions
    • Use additional code if it is applicable for any associated gallbladder gangrene (K82.A1), or gallbladder perforation (K82.A2)
  • Disorders of gallbladder in diseases classified elsewhere (there are new codes)
    • K82.A1 – Gangrene of the gallbladder in cholecystitis 
    • K82.A2 – Perforation of the gallbladder in cholecystitis 

With so many complexities and regular billing and coding changes, gastroenterology practices often benefit from help from an expert. Outsourcing your GI billing and coding to a quality company that has experienced, certified professionals can help your practice ensure clean claim submission in order to reduce denials and maximize your practice revenue. M-Scribe specializes in GI billing and coding, works with all practice management software, and can provide your practice with the accuracy needed to keep the revenue cycle moving while increasing revenues. To learn more about how we can help your gastroenterology practice deal with billing challenges and improve revenue, contact M-Scribe today. 


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