Coding is an essential aspect of medical billing and reimbursement, especially for gastrointestinal (GI) procedures. It involves the use of standardized codes to accurately describe the procedures and services provided to patients.
Some common examples of GI procedures include colonoscopies, endoscopies, and biopsies. To code accurately for these procedures, it is important to understand the specific procedure being performed and the specific codes that are used to describe it. Providing healthcare services need not necessarily require having an in-house medical billing department; you can always choose to outsource these services to a medical billing company after researching their background expertise.
The percentage of denials, for example, can be a significant aspect to consider. It is estimated that there are 5% to 10% denials in the industry; choosing a billing team based on these numbers can help your GI practice gain a healthy cash flow.
Aggregated statistics of claims processed by expEDIum report that over 80 clinics and 230 providers have submitted around 640K claims for reimbursement, and more than $168M has been reimbursed across these claims. These claims include HCFA-1500 and UB04 for Gastroenterology/Anesthesia/Ambulatory Surgery (ASC) specialties. However, if we consider only the last 12-month period, 160K claims were processed over expEDIum after assessing only the true denials. Additionally, along with the $0 payments factored in, the denial rate has been reported to be less than 10% during this time. Listed below are the typical denials that happened due to incorrect coding, and note that these data were derived from standard ERA HIPAA remarks and reason codes.
- The procedure was not paid separately (bundling issue).
- The procedure code was invalid on the date of service.
- The procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirement.
- The procedure code is inconsistent with the modifier used, or a required modifier is missing.
- The procedure should be billed with the appropriate code for these services.
- The procedure code/type of bill is inconsistent with the place of service.
- Procedure code incidental to the primary procedure.
- The procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.
The data above shows how coding can have a significant impact on the revenue. Therefore, when coding for a GI procedure, the first step is to determine the specific CPT code that describes the procedure. This can usually be found in a coding manual or online resources like the American Medical Association (AMA), AAPC, and similar ones. Once the appropriate code has been identified, it should be reported on the claim form or electronic submission along with any other relevant information, such as the diagnosis code and the provider’s National Provider Identifier (NPI) number.
It is important to be as accurate and specific as possible when coding for GI procedures, as this can have a significant impact on the reimbursement that is received for the procedure. Inaccurate or incomplete coding can lead to delays or denials of payment, so it is important to take the time to ensure that the coding is correct.
There are several reasons why coding is important for GI procedures:
- Accuracy: Coding ensures that the correct procedures and services are accurately documented and billed to the appropriate payer. This helps to prevent errors and misunderstandings that can lead to delays or denials in reimbursement.
- Compliance: Coding helps medical practices stay compliant with billing and documentation regulations. This is especially important for GI procedures, as there are many specific codes and guidelines that must be followed.
- Reimbursement: Proper coding is essential for getting paid for the procedures and services provided. Accurate coding ensures that the correct amount is billed to the payer, which helps to maximize reimbursement.
- Data collection: Coding also plays a role in the collection of data on medical procedures and trends. This data can be used to improve patient care, inform research, and support the development of new treatments and technologies.
In summary, coding is important for GI procedures because it helps to ensure accuracy, compliance, and reimbursement, as well as support data collection efforts. It is essential for medical practices to have a thorough understanding of coding guidelines and best practices in order to provide high-quality care to their patients. If interested, you can get in touch with our team of experts or visit our site here for more information.