Gastroenterology Coding Alert

Boost your bottom line by freeing up GI's timeMaximizing your evaluation and management service reimbursement for hepatitis patients is easier than you think. Follow four tips, and you'll learn how to make the most of your initial consult claims through diagnosis and follow-up.Tip 1: Fully Document the Initial VisitGenerally, the first service you will report for a potential hepatitis patient is a consult (for example, 99241-99245, Office consultation for a new or established patient ...), during which the gastroenterologist will take steps to confirm the diagnosis.When it's properly documented, you will usually find that the consult is a high-level service. Typically, most first visits with a possible hepatitis patient involve a high level of decision-making. The doctor must evaluate risk factors, order lab tests and possibly provide counseling. Medical decision-making would fall into the moderate-complexity range for most patients. Most properly documented visits would probably fall into the 99243-99244 range."For our Alaskan practice, this is especially true as we usually get patients with little or no long-term care," says Joyce Carpenter, CPC, OGS, MCMC, billing lead at Internal Medicine Associates in Anchorage.Example: The gastroenterologist sees a patient at the request of the patient's primary-care physician. The patient complains of severe fatigue and rapid weight loss and shows signs of jaundice.After performing a comprehensive history and exam with moderate medical decision-making, the physician diagnoses acute hepatitis C without hepatic coma.The gastroenterologist records his findings and provides a report back to the requesting physician.For this visit, you should claim 99244 (... requires these three components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity) for the initial consultation.Caution: Be sure you have met all the documentation requirements for a consult before billing the visit as such. If you cannot meet the requirements to report a consult, you will have to code a lower-paying outpatient E/M service (99201-99215, Office visit for the evaluation and management of a new or established patient...).Tip 2: Report Panel When Parts PerformedOne often-requested lab test is 80074 (Acute hepatitis panel) for a hepatitis panel. The panel combines several tests, including the hepatitis B surface antigen (87340), hepatitis C antibody (86803), hepatitis B core IgM antibody (86705), and hepatitis A IgM antibody (86709).The panel includes all the above individual tests. You should bill the panel code when your physician performs all the component codes, says Amy Hilderbrand, CPC, billing specialist for Gastrointestinal Specialists of Georgia in Austell.When to order a panel: CMS gives two indications of when you may provide a hepatitis panel:• To detect viral hepatitis infection when there are abnormal liver function test results, with or without signs or symptoms of hepatitis.• Prior to and subsequent to liver transplantation.Patients with a negative result may [...]