Gastroenterology practices have specific medical billing and coding challenges. Since this field requires both medical and surgical aspects, gastroenterology medical billing can be complex and necessitates an in-depth understanding of gastroenterology CPT codes.
This guide for gastroenterology medical billing best practices will help optimize your billing processes and boost your revenue cycle management!
What is Gastroenterology Medical Billing and Why Does it Matter?
Gastroenterology medical billing encompasses the related codes and practices of invoicing insurance companies for a patient’s gastroenterology procedure. Utilizing accurate medical coding ensures that insurers have all the diagnostic codes required for appropriate payment. Correct coding is also critical for demographic assessments and studies of disease prevalence, treatment outcomes, and accountability-based reimbursement systems.
Essentially, gastroenterology medical billing is important for the success of your organization and the community you serve.
Common Gastroenterology CPT Codes
There are nearly 72,000 ICD-10-CM codes to choose from, and it is often difficult to find the exact code when doing a search in the electronic health record and billing system. Staff education and training are essential to make the billing sector of your practice as efficient as possible when navigating medical codes and guidelines.
Here are some common gastroenterology CPT codes to start with:
Diarrhea
K52.2 Allergic and dietetic gastroenteritis and colitis
K52.89 Other specified noninfective gastroenteritis and colitis
R19.7 Diarrhea, unspecified
Abdom Pain Ot/Multi Site
R10.10 Upper abdominal pain, unspecified
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified
Benign Neo Rectum/Anus
D12.7 Benign neoplasm of rectosigmoid junction
D12.8 Benign neoplasm of rectum
D12.9 Benign neoplasm of anus and anal canal
Flatulence Eructation/Gas
R14.0 Abdominal distension (gaseous)
R14.1 Gas pain
R14.2 Eructation
R14.3 Flatulence
Benign Neo Lg Bowel
D12.0 Benign neoplasm of cecum
D12.1 Benign neoplasm of appendix
D12.6 Benign neoplasm of colon, unspecified
K63.5 Polyp of colon
Crohn’s Disease
K50.10 Crohn’s disease of large intestine without complications
K50.111 Crohn’s disease of large intestine with rectal bleeding
K50.112 Crohn’s disease of large intestine with intestinal obstruction
K50.113 Crohn’s disease of large intestine with fistula
K50.114 Crohn’s disease of large intestine with abscess
K50.118 Crohn’s disease of large intestine with other complication
K50.119 Crohn’s disease of large intestine with unspecified complications
Top Medical Billing Tips for Gastroenterology Practices
For the most optimized medical billing experience, here are some of the best practices for gastroenterology medical billing.
1. Medical Billing is a Team Effort
The physician is responsible for accurate and specific documentation and bringing charges back to the billing staff for claim submission. Billing staff need to communicate any significant changes to the physicians or providers as these changes occur. Physicians and coding staff need to have an open line of communication to make sure that everything is submitted appropriately according to payer policies.
2. Bill Appropriately for Evaluation & Management (E&M) Services
Evaluation and management services are the first steps taken for patients at any gastroenterological practice. Three criteria have to be met to support any initial visit with patients: the history obtained, the examination performed, and the development of the treatment plan. There are five levels of service for office visits and three levels for inpatient visits, respectively, so it’s important to select the most accurate level when billing.
3. Language for Diagnostic Studies
Medical necessity for testing must be documented in order to submit charges for diagnostic studies. Verbiage like “rule out” or “suspect” don’t completely give coders the reason why a physician suspects the patient might have a condition - usually, abnormal lab tests, signs, and symptoms will often warrant the need for further investigation, and these are the most crucial indications for testing. Make sure that the interpretation of the test results is clear along with a plan or recommendation for next steps.
Enhance Your Medical Billing Experience With NCG Medical!
NCG Medical understands billing can be rife with challenges and confusion. We’ve spent the past 40 years tailoring our medical billing services to meet the needs of many different specialties, including medical billing, revenue cycle management, credentialing, and more. Our gastroenterology insurance billing services can give you the medical billing expertise your practice needs to grow and thrive in today’s modern medical landscape. Contact our billing experts today and experience what NCG Medical can do for your revenue cycle management!
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