gastroenterology

  1. M

    Wiki Humana Mcr Diagnosis code issue

    When billing colonscopies/egds for our practice-physician orders colonoscopy for positive cologard (r19.5) pathology comes back nothing found. We obviously leave r19.5. Humana pays procedure but denies pathology for dx code issue. Why? We have never had issues with this. Physician orders egd for...
  2. M

    Wiki BCBS Denying Pathology Claims

    Has anyone been having issues with BCBS denying pathology claims since maybe June/July of 2024? We have denials and all they can say is since Avalon take over there are new guidelines- things such as k29.50, k21.00, and k22.89 cannot be coded together. Or k22.2 and k21.9 cannot be coded...
  3. J

    Wiki EUS

    Hi everyone! I have a question. My doctors always do EGD with EUS but during the EUS they sometimes look at the pancreas. Now my question is which code do I use? Would 43237 fit? Or 43259? These codes can be confusing. Please help!
  4. S

    Wiki Gastritis/Metaplasia

    I just began coding GI recently and I am regularly seeing EGD path reports with a diagnosis of "chronic gastritis with intestinal metaplasia." Would it be correct to use codes K29.50 + K31.A0 together for this? I am currently training with a coworker on GI procedures and I used those two codes...
  5. A

    Wiki Parastomal hernia polyp

    Patient presents with multiple polyps on a parastomal hernia that is affecting the fit of the ostomy. Provider destroys the polyps by hyfrecation. Any thoughts on a CPT code? The best we can come up with is 17110. We can't use 44401 because this all happened outside of the body.
  6. J

    Wiki J-Pouch with polyp diagnosis help!!

    I have a patient who had a total colectomy and has a J-pouch. They had a pouchoscopy which showed polyps that were removed, what ICD code would I use for polyps of an ileal pouch? The patient does not have any of their colon or rectum so I cannot use those codes, and the area of intestine is...
    • jodielonkoski
    • Thread
    • crohn's gastroenterology icd 10 ulcerative colitis
    • Replies: 2
    • Forum: ICD-10
  7. S

    Wiki What is happening with Modifier 33?

    I work in a GI clinic, and we use modifier 33 and modifier PT all of the time. I am now getting claim rejections for these modifiers, that the procedure codes we are using are inconsistent with the modifier used. How are we to let insurances know that these are preventative services?
  8. L

    Wiki diverticulitis perforation vs crohn's disease

    i have a hospital follow up patient that has the chief complaint of "perforation and abscess of large intestine concurrent with and due to diverticulitis". The imaging shows a left colon perforation. the patient also has "medically difficult to manage IBD". it was difficult for the physician to...
  9. V

    Wiki GI Op Reports Audit Tool

    Hi, Does anyone have an Endoscopy and/or Colonoscopy Audit tool they are willing to share:
  10. J

    Wiki Heaven help me!

    Hello! My name is Jordan and I am recently employed in a Colorectal Surgeon practice that also houses a GI doctor for IBD and they all do Inpatient rounds as well as procedures and surgeries. This office has lacked a coder, biller, A/R person for at least a year and is in just a mess. I have a...
  11. J

    Wiki oh heaven help me.

    Hello! My name is Jordan and I am recently employed in a Colorectal Surgeon practice that also houses a GI doctor for IBD and they all do Inpatient rounds as well as procedures and surgeries. This office has lacked a coder, biller, A/R person for at least a year and is in just a mess. I have a...
  12. J

    Wiki INPATIENT --- Over My Head

    Hello! My name is Jordan and I am recently employed in a Colorectal Surgeon practice that also houses a GI doctor for IBD and they all do Inpatient rounds as well as procedures and surgeries. This office has lacked a coder, biller, A/R person for at least a year and is in just a mess. I have a...
  13. D

    Wiki Looking for opinions on capsule reading and billing global

    Good Afternoon All, If a provider is buying the capsule cams, has the download center equipment and is paying someone to read their capsule but then reading it themselves and signing the note that the provider read the test; would this be allowed in order to bill globally? I was told if the...
  14. T

    Wiki PEG Tube Placement-CoSurgeons

    When GI doc does an EGD with PEG placement, GI doc is doing the upper endoscope and they call in a surgeon (from different practice) to perform the placement of the PEG. I usually code 43246 with modifier 62 for my GI doc. Lately we have been receiving denials, and the surgeons office has been...
  15. J

    Wiki 2017 moderate sedation - multiple procedures, same dos

    Our physician is coding 45380 & 45385 with 99152 & 99153. Additionally, he's also coding 43235 with 99152. Does anyone know if we are allowed to bill 99152 twice? Also, if billed twice is modifier 59 appropriate on the second 99152? :confused:
  16. A

    Wiki Hemorrhoidectomy

    My surgeon has a Exam under Anesthesia(45990) and Internal/External Hemorrhoidectomy(46260) listed on the op report. My question is, wouldn't the EUA be part of the procedure and not billable as separate? Any input would be appreciated.
  17. V

    Wiki Lawrenceville, GA Gastro Coding position available

    Looking for experienced Gastro coding and experienced Billing CPC. Gastroenterology coding, full time, well established practice near Gwinnett Medical Center
  18. D

    Wiki Question for you Gastro billers out there!

    Hello All, I wanted to get some opinions on a few things: 1. If my doctor sees a patient prior to colonoscopy screening and the patient is there to just go over the colonoscopy steps and sign consents. Are we able to charge for this visit? I have seen where it states if just there for a...
  19. B

    Wiki Multi-Specialty Surgical Coder seeking full-time position

    I'm currently employed with a multi-specialty surgical practice and I'm interested in exploring other opportunities, I would love to speak with you about my coding and auditing experience. https://www.linkedin.com/in/brenda-wray-cgsc-cpma-cpc-a20a7713 brendawray9@gmail.com Best Regards...
    • Bwray
    • Thread
    • gastroenterology general surgery oncologic thoracic vascular
    • Replies: 2
    • Forum: Resume Postings
  20. M

    Wiki Colonoscopy Medical Decision Making Risk

    I am in the process of conducting an E&M audit for a gastroenterology practice. The majority of the patients are being seen for evaluation and subsequent scheduling of a colonoscopy. Most are due to family history and preventive reasons. While endoscopic procedures do carry risk i'm just not...
  21. J

    Wiki EGD wi dilation, fluoroscopy &59 modifier?

    I am getting NCII edits when I code EGD with Maloney or Savory dilation on the fluoroscopic guidance code. The 76000 hits against the 43235/43239 code (not against the actual dilation code 43235) or the 43248 Savory dilation code. In reading descriptions of the procedures, it doesn't say that...
Top