Gastroenterology Coding Alert

Use This Field-Tested Checklist to Make Your Work More Efficient and More Effective Gastrointestinal coding is part art form, part mechanics. Successful coding requires accuracy, persistence and constant attention to detail. Above all, great coding is about "knowing the rules, the specific rules for each carrier even if they are inconsistent with the rules of other carriers or even the standard CPT rules or Medicare's rules," says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel.
 
By mastering certain basic practices - and making them second nature - you'll be ahead of the game when it comes to beating the odds on reimbursements and appeals.
 
Use the tips below to make sure you've covered the basics of correct coding:  1. Sweat the small stuff. Understanding your carriers' rules about how to use modifiers can increase your reimbursement potential. For example, Sherri Brasher, insurance and billing specialist with Gastroenterology Associates in Evansville, Ind., understands how her carriers want multiple-procedure modifiers used - and it's made a huge difference in the success of their billing. "Sometimes we use -51 (Multiple procedures), but with some carriers we use -59 (Distinct procedural service), especially with some of our commercial insurances because they won't pay with the -51. Instead we've been attaching -59 and -51, letting them know it's distinct and separate, and also it's multiple procedures."  2. Speaking of the small stuff ... Strive for the most detailed diagnosis you can. Fourth and fifth digits on ICD-9 codes will improve your chances of getting reimbursed and, more important, they provide you with a greater capacity for patient tracking and disease management.  3. Always base your coding on medical record documentation. Be fanatical about reviewing documentation to be sure the record supports the codes selected. It helps to have all of the patient's documentation in front of you so you can make the proper choices while you're coding, says Jill Barron, CPC, coding manager for Gastroenterology Associates of Cleveland. "I also code all of my procedures off of the op reports, so I don't even enter the procedures until I have the op reports," she adds.
 
And never assume! If you have a question about a code or a comment your physician has made in a patient's record, do not assume what she meant. Guessing or submitting paperwork you don't feel comfortable with will come back to bite you. Always speak with the physician, Barron advises. "I'm not going to assume. I always go back to them."  4. Formalize error-checking. Regularly check billing reports for minor errors - before they go out - to prevent denials and payment delays. Keep a "Most Wanted" list to remind yourself of the [...]