Know Your Gastroenterologist Billing Codes and Modifiers to Ensure Proper Documentation

According to a report, 52% of self-employed gastroenterologists saw a 25% decline in patient volume that they considered permanent. For any gastroenterologist practice, these are alarming numbers; for others, it is a wake-up call. It goes without saying that as a gastroenterologist, you need to be privy to money matters in order to run a successful gastroenterologist practice.

It is also no secret that gastroenterologists offer both surgical and medical services, and as a result, they are often faced with complex billing and coding challenges. This is the main reason why medical billing and revenue cycle management is often outsourced to medical billing experts.

So, what are these major coding and billing points that every gastroenterologist needs to be aware of, especially in 2021? Let’s take a look at some of the areas of a gastroenterologist’s practice that may require your attention in order to increase revenue and streamline the entire payment process.

Proper Documentation

This is a no-brainer. As a gastroenterologist practice, you need to ensure the proper documentation of all of your patients who walk through the door. For effective billing, proper documentation is required for correct code assignment and to show medical necessity. Failure to demonstrate medical necessity can result in claim denials as well as authorization denials for lab tests, medicines, diagnostic investigations, and other services.

Medical necessity/indication for testing must be documented when invoicing diagnostic tests and treatments. The most important red flags for testing are usually abnormal lab tests, indications, and symptoms. This is why the interpretation of the test findings and any recommendations should be included in the documentation.

Also, new rules and regulations state that the documentation for endoscopy and procedural billing must include the technique used to treat the area within the gastrointestinal tract, the location of lesions/abnormalities, method of treatment/removal, and the reason(s)/indication(s) for those procedures, in addition to medical necessity. Distinct colon tools can be recorded individually with an appropriate modifier to indicate that they were utilized to treat different lesions/abnormalities. To charge each surgery, all of these facts must be included in the endoscopic report.

E/M Guidelines

In 2021, there will be special improvements to gastro-specific E/M services. To optimize medical billing and maximize reimbursement, clinicians must understand how to correctly document and code Evaluation and Management (E/M) patient visits. E/M codes are now allocated depending on one of two factors: time or medical decision-making (MDM). CPT, for example, modified the concept of time linked with 99202-99215 starting in 2021. And, that’s not all that a gastroenterologist practice needs to take care of while providing their services in 2021. The following are some of the key areas that are crucial to providing a better quality service to their patients:

• Care coordination
• Counseling and education patient/family
• Documenting the care
• Independently interpreting and communicating test resultsto the patient/family
• Obtaining separately obtained history
• Ordering medication, tests,or procedures
• Performing the exam
• Preparing to see the patient
• Referring and communicating with other health care professionals
• Reviewing separately obtained history

Proper Management of Adjustments or Collections

Begin tracking patterns in insurance and patient collections. Keep track of unpaid insurance and patient collections, as well as the number of days it takes for payment to be received. Calculate the adjusted collection rate by dividing the total charges by the amount of all payments minus refunds. Your practice should aim for an adjusted collection rate of more than 95%, according to industry norms. Monitor payment lag, or the time it takes for an expected payment to arrive, to see whether you need to take action.

Set practice-wide rules regarding when charges must be billed to help maintain regular monthly payments. The gastroenterologist practice can more precisely estimate cash flows by measuring collection rates and monitoring modifications. Tracking collections and adjustments will help you identify payers and patients that are negatively impacting your practice’s cash flow.

Use the Correct Modifiers Correctly

The discrepancy between modifier 51 and modifier 59 is one of the most prevalent gastrointestinal coding errors. Both of these modifiers are utilized when several services are performed, although they serve distinct objectives. Modifier 51 denotes that the same clinician conducted numerous operations (other than E/M) within the same session. When the operations are ranked in order of RVU, modifier 51 is used to identify the second and subsequent surgical procedures to third-party payers, but it is not added to the primary procedure based on what was done to address the patient’s ailment.

Also, Modifier 59 Unique Procedural Service denotes that an operation is distinct from another procedure performed on the same day. Modifier 59 can be used for many sessions or encounters on the same day of service; a different operation from the initial procedure; a different anatomic site; and a separate incision, excision, damage, or body part.

Assign the Right ICD-10 Codes

The medical need for the services given is supported by ICD-10 codes. Medical coders should assign diagnostic codes to the highest degree of specificity reported, just as clinicians must document the most exact clinical diagnosis. This is necessary for appropriate reimbursement and correct claim submission. When a physician is unable to make a diagnosis for an encounter, the condition or conditions — such as symptoms, signs, abnormal test findings, or another cause for the visit — should be documented as accurately as possible. Comorbidities can be coded to aid decision-making at a higher level.

No matter what your billing or coding concerns are, JBF Medical Billing, LLC. can ensure that you’re covered when it comes to medical billing and revenue cycle management. JBF Medical Billing, LLC. is an experienced and reliable billing service exclusively for Gastroenterologists and Gastroenterologist-related practices. What makes this service unique is that we offer it specifically for gastroenterologists and gastroenterologist-related practices. This means that your medical billing is being taken care of by the experts.

JBF Medical Billing LLC. is also a proud member of the American Gastroenterological Association (AGA), the American Association of Healthcare Administrative Management (AAHAM), and the American Medical Billing Association (AMBA), so you can rest assured all of your Revenue Cycle Management and HIPAA Compliance are taken care of by the experts.