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Outsource Gastroenterology Billing Services

Apr 18

Gastroenterology is the field of medicine dealing with diseases related to the digestive tract. It includes all the organs from the esophagus (food pipe), stomach, small & large intestine, colon, rectum, pancreas, gallbladder, liver, and bile ducts. Gastroenterology deals with diseases related to the luminal gastrointestinal (GI) tract. Some of the conditions include:

  • Hepatitis
  • Esophageal cancer
  • Crohn’s Disease
  • Pancreatitis
  • Gallbladder stones and cancer
  • IBS - Irritable Bowel Syndrome
  • Pancreatic Cancers
  • Gastric cancers

Gastroenterology deals with diagnostic procedures and treatment related to the disorders mentioned above. 

What is medical billing for Gastroenterology?

There are various healthcare specialties that are comparatively complex to code, and gastroenterology is one of those. Several medical billing challenges are associated with gastroenterology practice. Medical billing for this specialty involves getting reimbursed against the procedure(s) performed by the physicians. The gastroenterology healthcare practice must have a well-trained and qualified medical billing team. Along with that, implementation of ICD-10 codes and HIPAA compliance is also a must for the healthcare practice. Errors in medical billing and coding are very common across all specialties resulting in a low reimbursement rate and affecting the revenue cycle. Outsourcing pediatrics medical coding is one of the most common practices adopted by various healthcare providers. There are several companies offering medical billing outsourcing services, helping in the growth of the healthcare practice.

Outsourcing Gastroenterology Medical Billing Services:

Maintaining a balance between providing safe patient care and correct medical billing is essential for any healthcare practice. In-house medical billing can lead to various errors & challenges, therefore, late payments and increased medical claim denials or rejections. In order to ensure error-free medical coding, healthcare providers need to focus more on the following:

  • Coding Accuracy
  • Timely submission
  • Complete documentation

Outsourcing billing services to a well-reputed medical billing company comes with several benefits. Some of the benefits include:

  • Lesser errors
  • Lesser claim denials
  • Faster payments 
  • Higher reimbursement rate
  • Improved revenue cycle
  • More focus on the patients
  • Lesser administrative or fixed costs

Outsourcing gastroenterology billing services involves a team of highly skilled medical billers working only to improve the revenue cycle. UControl Billing is a well-reputed outsource medical billing company offering competitive pricing. The professional medical billing team of UControl Billing is proficient in:

  • Improving the coding accuracy
  • ICD 10 CM, CPT, HCPCS, NDC, and Modifiers
  • Provider note Audits
  • Code Reviews
  • Specialty and Payer specific coding requirements
  • Faster turnarounds

By outsourcing the medical billing services to UControl Billing, you get:

  • Increased reimbursements and cash flow
  • Accurate submission 
  • Claim Scrubbing
  • Reduced claim denials and rejections
  • Eligibility verification
  • HIPAA Compliance

Errors in Gastroenterology Medical Coding:

Following are some of the most common billing errors or mistakes in gastroenterology services:

  • Use of incorrect modifiers:

Using an incorrect modifier is one of the most common medical coding errors of gastroenterology, resulting in low reimbursements. Confusion between modifiers 51 and 59 is the most common error caused mostly due to mistakes in endoscopic coding.

Modifier 51 in medical billing is used when the physician performs two or more procedures or services in the same treatment session; on the same day. Note that it involves procedures for two different coding categories. 

However, modifier 59 in medical billing indicates a “distinct procedural service.” It indicates that the services or procedure performed is independent of any other procedure performed by the physician on the same day. Confusion between these two modifiers results in the claim being denied or rejected. 

  • Upcoding:

Gastroenterology E&M (evaluation and management) codes are allowed for both new and established patients. Higher reimbursements are associated with new patients compared to established patients. Because more work is required for new patients than that of the established patients (mentioned by CMS). This is why coding the follow-up of an established patient, equal or at the same level as the new patient, is considered upcoding. 

  • Use of incorrect codes:

Every year, CPT codes are being updated by the American Medical Association (AMA). It also includes billing codes for gastroenterology and various other healthcare specialties. Using the right and updated codes along with the correct modifier is critical for proper gastroenterology billing. In healthcare specialties, physicians, healthcare practices, or billing staff must be up-to-date regarding all the recent changes in the codes. As well as ensure following the official guidelines and the use of correct modifiers with the CPT codes. This helps reduce the claim denials and therefore improve the revenue cycle. 

  • Eligibility criteria:

For gastroenterology billing, the insurance eligibility of the patient must be verified. The patient’s details must be accurate and updated for insurance eligibility to avoid errors in medical billing. Incomplete verification leads to the claim being rejected or denied.

  • Incomplete documentation and patient record:

Insurance payers are constantly mentioning the need for medical necessity and complete documentation. Patient documentation must indicate the medical necessity behind the procedure performed. The information must be accurate and complete to avoid any miscoding. As incorrect information leads to the use of wrong codes, therefore, resulting in claim denials. 

Tips for Gastroenterology Billing Practices:

Following are some of the tips to reduce any errors associated with gastroenterology billing.

  • Correct documentation and medical coding
  • Evaluation and Management services 

When we talk about tips specific to gastroenterology, the following are some of them:

  • In gastroenterology, control of bleeding isn’t billed separately. However, it can be billed separately only when a patient shows up with a GI bleed. This is the most common reason why the endoscopy is performed. The procedure involving the most control of bleeding is endoscopy. 
  • ICD-10 codes are used to report or bill screening colonoscopies. Note that there is a difference between screening and diagnostic colonoscopy procedures.
  • If polyps are found and removed during a screening colonoscopy, a separate modifier is required to report the screening procedure by Medicare. Along with the modifier PT, the use of the correct CPT code is also essential. 

Avoiding and reducing the errors and mistakes as mentioned earlier in gastroenterology medical billing results in:

  • Lesser claim denials and rejections
  • Higher clean claim rate
  • Higher reimbursements
  • Faster payments
  • Improved revenue cycle

What is Gastroenterology?

This field or specialty of medicine deals with disorders related to the digestive tract. It particularly focuses on the conditions associated with the GI tract. This field involves some gastroenterologists focusing on the specific types of conditions and others on general diseases. Particularly, a gastroenterologist can be called in for:

  • Abdominal pain
  • Colon cancer or polyps
  • Jaundice 
  • Hiatal Hernia
  • Liver Disease
  • Ulcers
  • Vomiting
  • Heartburn
  • Diarrhea
  • Rectal bleeding
  • Irritable Bowel Syndrome (IBS)
  • Gastritis
  • GERD. 

A gastroenterologist can only diagnose and provide medical treatment; they don’t perform any surgery. Some of the procedures performed by the gastroenterologist are listed below:

  • Liver Biopsy
  • Endoscopic examinations of the esophagus and stomach
  • Including endoscopic examination of the large and small bowel.
  • Endoscopic ultrasounds (examining the upper GI tract, lower GI Tract, and other internal organs as well)
  • For examining the small intestine; double-balloon enteroscopy and capsule endoscopy
  • Inserting feeding tubes into the abdomen is also known as Feeding tube insertion.

Depending on their condition, the patient may need to visit a gastroenterologist as this specialty comprises various conditions. Based on the symptoms of the patient, the treatment plan and care are devised by the specialist.