Accurate and precise medical coding is a must for any gastroenterology practice.
The challenges for the field of gastroenterology are many in the new environment of the trend toward the accountable care concept, a concept that exposes this specialty to demands for varied and integrated care in a manner which is economically sound for the consumer yet profitable for the physician. These challenges call for a concerted effort to streamline office procedures and create a more efficient working environment all while attending to the concerns of the practice and remaining a desired, viable, vital specialty. Extensive and continual educational and training requirements pose further demands on the time and resources of the practice, and can cause a profound delay in the optimal outcomes of value-added returns due to an extended learning and implementation curve.
Coding errors can also severely impact the bottom line of the gastroenterology practice and create problematic issues for an extended time period if there are inconsistencies in diagnosis and procedural claims. One of the most common errors noted in coding for gastroenterology includes miscoding colonoscopy procedures for asymptomatic patients in terms of the nature of the screening and whether it should be coded as a surveillance or screening colonoscopy. The immense scope of payable categories within the field requires a broad familiarity with new and updated codes in order to deter denials and protect reimbursements. Even supply items can be cause for rejection if coders are not current with guidelines. One of the most rejected supply claims includes a PEG-J being claimed to the wrong jurisdiction in such cases as when used to establish a transabdominal port by endoscopic procedure. PEG-Js must be claimed as a supply to the A/B MAC contractor.
PDN understands the many challenges of coding for gastroenterologists, especially for those employed in-office, accustomed to working with prior CPT and ICD-9 codes. The new demands created by ICD-10 for increased documentation and specificity require an advanced knowledge base with regard to anatomy and terminology, and a more complete understanding and awareness of gastroenterology diagnoses and procedures. For instance, the ICD-10 has nine different coding options related to colon polyps:
D12.0: benign neoplasm, cecum
D12.1: benign neoplasm, appendix
D12.2: benign neoplasm, ascending colon
D12.3: benign neoplasm, transverse colon
D12.4: benign neoplasm, descending colon
D12.5: benign neoplasm, sigmoid colon
D12.6: benign neoplasm, colon unspecified
K51.4: inflammatory polyp of colon
K63.5: polyp of colon NOS
Coders must be able to review completed pathology reports to ensure accurate claim translation of polyp diagnosis. This is extremely important as all claim data must be consistent across all past, present, and future claims. 2015 also saw over 50 changes in CPT codes related to the field of gastroenterology, including codes for lower GI endoscopy, definition revisions associated with colonoscopy, and G codes and modifiers for Medicare and Medicaid (CMS) claims. CPT code changes in 2016 include esophageal fundoplasty (new code 43210), esophageal balloon distension studies (revised code 91040), and liver elastography (91200).
Certified gastroenterology coders provide seamless and accurate services in a timely manner, and are able to integrate E/M functionalities with highly specialized procedural documentation to capture and translate data in an efficient manner which reduces compliance risk and increases revenues. Don’t hesitate to seriously consider the advantages of outsourcing your coding needs to PDN’s certified coders. All of our experienced and highly qualified coding professionals make a striking difference in the level of efficiency in the office, help to build reliable revenue streams, and protect the practice from audits and non-compliance.