Mastering Colonoscopy Coding: Tips, Nuances, and Medical Necessity

This webinar will explore the Ins and Outs of coding for Colonoscopies. Colonoscopy tips and nuances will be expounded upon. These tips and nuances will elaborate on the differences between screening and diagnostic colonoscopies. Modifiers PT and 33 will be explored. The applicable HCPCS and CPT® codes will be itemized, and high and low risk colonoscopy criterion will be discussed. We will also touch on documentation and what to look for to substantiate the colonoscopy being coded.

In addition to the above, medical necessity for colonoscopies will be explored. The applicable diagnoses codes and conditions will be itemized. Custom flowcharts have also been formulated to ensure the right code and modifiers are selected for use. Examples of different coding scenarios for colonoscopies will be included in the presentation as well.

Learning Objectives/Agenda

• What is a Colonoscopy?
• Screening Vs. Diagnostic Colonoscopies
• Medicare Vs. Commercial
• Modifiers
• Colonoscopies: Low Risk Vs. High Risk
• Documentation
• Flow Charts
• Colonoscopy Decision Tree from the CPT® Manual
• Medical Necessity
• Examples

Why is this topic important?

Identifying and coding colonoscopies correctly can have a huge impact on denials and reimbursement. Understanding the nuances can greatly contribute to the success of a department and their bottom line. Knowing what to look for in the documentation and what is applicable to the topic is important to the proper coding of colonoscopies as well.

Who would benefit from this topic?

• Medical Coders
• Medical Billers
• Providers
• Any role essential to the documentation process
• Pathology
• Leadership and Educators

What’s the presenter's background/expertise on this topic?

As a medical biller, I’ve worked many denials in relation to this topic. As a medical coder, I’ve deciphered the differences between the different colonoscopies when coding this topic. As a Revenue Integrity Analyst, I corrected many claims on the backend after they denied for improper coding practices and as a Coding Educator, I’ve identified the nuances that seem to be confusing and created education tools to assist with properly coding and documenting on this particular topic. My ultimate goal is to train others from all angles on this topics and instill in them the knowledge it took me a while to obtain.

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