
































Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
Community
Ask the community for help and clear up your study doubts
Discover the best universities in your country according to Docsity users
Free resources
Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors
An in-depth analysis of billing diagnosis and procedures in endoscopy. It covers various aspects such as federal regulations, ICD-9 codes, CPT codes, and billing for diagnostic studies and surgeries. The document also explains the concept of E&M services and modifier 25, as well as the calculation of Total RVU and Medicare Conversion Factor. It is essential for medical students, residents, and healthcare professionals involved in endoscopy billing and coding.
Typology: Study notes
1 / 40
This page cannot be seen from the preview
Don't miss anything!
Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Louisville and Louisville VAMC
Billing Diagnosis Procedure + E/M on same day Billing in Endoscopy
Outpatient Visits
Requires valid indication/reason (necessity)
The final diagnosis;
Significant E&M on “Global Procedure Period”: MODIFIER 25
E&M in day of procedure is for “significant, separately identifiable E&M beyond the pre-operative and post-operative work of theprocedure” - If billing “inpatient dialysis code” (90935, 90337, 90945, 90947) you must document that “service was unrelated and could not beperformed during dialysis procedure”
E&M visit on the same day of endoscopy orminor surgery (e.g.: cardiac cath) is payable if“significant, and separately identifiable”(separate notes are needed). - Example: Patient admitted for “Unstable angina”;next day has normal cardiac cath; patient isdischarged in view of cath findings: Bill for “cardiac cath” and “E&M discharge service”on same day (with 25- modifier for E&M).
38.08 (peak value)
34.02 (24.84 was proposed)
Pre-approval required : - Obtain pre-approval for procedure giving clinical
No pre-approval required : - Be sure that the indication of the procedure is
If the Indication/Medical Necessity is not valid, you will not be paid (Is considered Fraud )
All normal diagnostic or screening exams are billed under:
All exams with abnormal findings related to the “indication” or which require intervention (eg. Bx, removal, dilat.) are billed under:
All exams with abnormal “incidental” findings not related to the “Indication /Medical Necessity” are billed under:
All SCREENING exams with normal or only incidental findings , should be billed under:
Endoscopy Billing Extent of Exam – Colon Family
-^ YOU SHOULD ALWAYS DOCUMENT THE MOST DISTANT POINT REACHED. - Colonoscopy : (45378-45387) Base RVU: F= 6.48; NF= 11. - if the splenic flexure is passed - Screening Colonoscopy: (G0105- high risk & G0121-average risk) - if the splenic flexure is passed - Sigmoidoscopy : (45330-45345) Base RVU: F= 1.90; NF= 4. - beyond the rectum and up to the splenic flexure - Screening Sigmoidoscopy: (G0104) - beyond the rectum and up to the splenic flexure - Proctosigmoidoscopy : (45300-45305) - Rectum + sigmoid only - Anoscopy : (46600-46606) - anus only - Colonoscopy via stoma (44388-44397) Base RVU: F= 4.97; NF=10.
Modifier when “Screening” Service is converted to Diagnostic/Therapeutic Service •^