Many independent physician offices utilize medical billing outsourcing because it makes sense. Small offices simply don’t have the expertise to do it themselves, but they understand the impact that medical coding and billing can have on their practice and realize its importance.
Coding and billing can be complex, especially for GI/Endoscopy. Thankfully, medical billing companies are aware of the specific codes and modifiers needed in order to properly bill for services rendered. A good medical billing company also knows the different billing guidelines issued by different insurance companies.
Important Things to Know
- Do not bill control of bleeding separately. Unless a patient comes in with a GI bleed that provides a need for endoscopy, most endoscopic procedures include control of bleeding. The CPT code used will depend on the location of the endoscopic clip used.
- If a biopsy is done on a lesion that is removed during the session, only the removal should be coded. The biopsy cannot be coded separately. There are cases, however, such as when one lesion is biopsied and another lesion is removed using a different method, that both the biopsy and removal may be coded with the use of modifier 59 to identify that two procedures not usually submitted together are appropriate given the circumstances.
- Codes for commercial insurers and Medicaid patients are different than codes for Medicare beneficiaries.
- If a colonoscopy cannot be completed because of an obstructing lesion or unusual patient anatomy, the procedure is termed incomplete and should be coded using 45378 or the appropriate G-code and modifier to indicate a discontinued procedure.
Know the Rules for Screening
Medicare has a separate modifier for polyps identified and removed during a screening colonoscopy. The correct CPT code must be used with a modifier. The G-code should not be used to bill for a screening. On the claim form, the screening diagnosis code should be listed first, followed by the code(s) for polyp or other applicable diagnosis.
Given the complexity, medical billing outsourcing makes good business sense. Medical coding companies like Medical Billing Services LLC, that have experienced, certified coders with knowledge of GI-specific coding skills and billing specialists can help maximize revenue.