Gastroenterology Coding Alert

Sorting out these office visits from the rest could be a saving grace You know that a high frequency of Crohn's patients makes these claims important; denials could cost your practice well-earned dollars. Our experts have broken down Crohn's diagnosis, management and treatment options so that you're never searching for your code again. First, Learn What Crohn's Is Crohn's disease, also called ileitis or regional enteritis, is an inflammatory bowel disease (IBD) that typically irritates the small intestine but can also occur in any part of the digestive tract. Those with Crohn's disease endure frequent pain from intestinal inflammation and often have diarrhea. The patients will find no cure for Crohn's disease, but several treatments are available. ICD-9 options: When selecting the diagnosis code, you should know which locations in the intestines the physician has identified with Crohn's inflammation. For instance, use 555.0 (Regional enteritis; small intestine) when the inflammation occurs only in the small intestine or ileum. Use 555.1 (... large intestine) when the physician sees only inflammation in the colon (large intestine). If the physician detects Crohn's inflammation in both areas, report 555.2 (... small intestine with large intestine). There may also be instances when the physician does not specifically mention the areas of inflammation. In those cases, the diagnosis code is 555.9 (... unspecified site). Watch out: "Make sure you have a definitive diagnosis -- not a suspected or rule-out. Otherwise, you have to go off the symptoms," says Joyce Carpenter, CPC, OGS, MCMC, billing department lead at Internal Medicine Associates LLC in Anchorage, Alaska. Sift Out the Consultation Visits Often a gastroenterologist's first encounter with a Crohn's patient is a consultation. The patient has some sort of gastroenterological problem, and her primary-care physician decides that a gastroenterologist's opinion is needed. "Most of our patients are sent as consults," says Dena Rumisek, biller for Grand River Gastroenterology PC in Grand Rapids, Mich. - Heads up: Even if another physician diagnoses a patient with Crohn's and she eventually comes under your office's care, the initial meeting with her is a consultation -- as long as the other physician requests the consult. - If the patient reports initially because her doctor decided that a gastroenterologist's opinion was in order, choose the appropriate code from the outpatient consultation codes 99241-99245 (Office consultation for a new or established patient ...). - If the gastroenterologist provides a second or third opinion about a patient with Crohn's symptoms, you should assign one of the outpatient office visit codes (99201-99205 for new patients, or 99211-99215 for established patients) or consult codes (99241-99245), whichever is appropriate for your setting and type of service. Decipher the Diagnostic Method Gastroenterologists have several options when testing for Crohn's [...]