Gastroenterology Coding Alert

Question: I think that I have a good handle on coding gastroenterology claims, but if I wanted to find areas to improve, where would you recommend I look?

California Subscriber

Answer: You can always find areas to improve. The top-two reasons for denials are ICD-9 codes, which most experts agree is the most important code, and modifiers.

For instance, you must choose the ICD-9 code based on the highest specificity. In the absence of a definitive diagnosis, you should code signs or symptoms. You can use more than one code to support a service, but your first diagnosis code is the primary reason/concern for the visit or the finding of the procedure. Always link the dx code with the procedure code, and include all the digits necessary. For 2008, gastroenterologists acquired new ICD-9 codes for dysphagia (787.20-787.29) and ascites (789.51-789.59).

For modifiers, you should review 2008 definition changes and keep abreast of carrier policies. You'll find that carriers vary on what modifiers they want. For instance, you should check Medicare bulletins for this information. And the majority of states have written policies that govern that you should not use modifier 51 (Multiple procedures) on any procedure; if you do, you'll face a denial. Carriers apply the multiple discount automatically.