Topics: Medical Billing, Revenue Cycle Management, Gastroenterology
Since gastroenterology practices can perform both medical and surgical services, your gastroenterology medical billing strategy has to take this into account. Billing for this specialty can be challenging but the friendly experts here at NCG want to make it simple for you to boost your healthcare revenue cycle.
We’ve put together this handy list of commonly used gastroenterology CPT codes so that you and your staff can quickly find what codes you’re looking for. Keep reading to learn the importance of using accurate gastroenterology CPT codes and more!
Quick Links:
- The Importance of Accurate Gastroenterology CPT Codes
- Frequently Used Gastroenterology CPT Codes
The Importance of Accurate Gastroenterology CPT Codes
An optimized healthcare revenue cycle means all components are as efficient as possible and that you don’t have to go back and redo the same thing over and over again. A cornerstone of such an efficient process is using accurate medical billing codes.
There are thousands of medical billing codes to correspond to thousands of healthcare procedures, tests, and services – so there’s no wonder why it can be a complicated process. Medical practices that submit inaccurate codes then have to deal with rejected claims. Reworking claims means spending unnecessary time and effort on something that ideally was done correctly the first time around.
To put it in perspective, your gastroenterology practice should have a clean claims rate of 95%, meaning that 95% of your claims are processed successfully on the first submission. Most practices fall a little short of this and have an average clean claims rate of 75%-85%.
Let’s say each claim costs $25 to rework and you have an average 100 claims that need to be reworked each month – that adds up to a hefty $2,500 a month and $30,000 per year! One essential step you can take to avoid these costs is to ensure each claim uses the correct gastroenterology CPT codes.
Frequently Used Gastroenterology CPT Codes
These medical billing codes are essential for your gastroenterology practice in 2023:
Gastroenterology CPT Codes for Diarrhea
- K52.2: Allergic and dietetic gastroenteritis and colitis
- K52.89: Other specified noninfective gastroenteritis and colitis
- R19.7: Diarrhea, unspecified
Abdominal Pain Ot/Multi Site CPT Codes
- R10.10: Upper abdominal pain, unspecified
- R10.2: Pelvic and perineal pain
- R10.30: Lower abdominal pain, unspecified
Benign Neo Rectum/Anus Gastroenterology Codes
- D12.7: Benign neoplasm of rectosigmoid junction
- D12.8: Benign neoplasm of rectum
- D12.9: Benign neoplasm of anus and anal canal
Gastroenterology CPT Codes for Flatulence Eructation/Gas
- R14.0: Abdominal distension (gaseous)
- R14.1: Gas pain
- R14.2: Eructation
- R14.3: Flatulence
Benign Neo Lg Bowel CPT Codes
- D12.0: Benign neoplasm of cecum
- D12.1: Benign neoplasm of appendix
- D12.6: Benign neoplasm of colon, unspecified
- K63.5: Polyp of colon
CPT Codes for Crohn’s Disease
Crohn’s Disease, also known as ileitis or regional enteritis, involves chronic inflammation of the digestive tract that results in abdominal pain, severe diarrhea, fatigue, weight loss, malnutrition, and more.
- K50.10: Crohn’s disease of large intestine without complications
- K50.111: Crohn’s disease of large intestine with rectal bleeding
- K50.112: Crohn’s disease of large intestine with intestinal obstruction
- K50.113: Crohn’s disease of large intestine with fistula
- K50.114: Crohn’s disease of large intestine with abscess
- K50.118: Crohn’s disease of large intestine with other complication
- K50.119: Crohn’s disease of large intestine with unspecified complications
Gastroenterology CPT Codes for Other Studies and Tests
Check out these CPT codes for other gastroenterology studies and tests, including motility tests and manometry services:
- 91010: Esophagus motility study
- 91020: Gastric motility studies
- 91034: Gastroesophageal reflux tests
- 91035: Gastroesophageal reflux test w/electrode
- 91037: Esophageal function test w/electrode
- 91038: Esophageal function test, less than 1 hour
- 91040: Esophageal balloon distention tests
- 91065: Breath hydrogen/methane test
- 91110: GI tract imaging, capsule endoscopy
- 91111: GI tract imaging, esophageal endoscopy
- 91112: GI wireless capsule measurement
- 91120: Rectal sensation test
- 91122: Anorectal manometry
- 91200: Liver electrography
- 91299: Gastroenterology procedure (other)
Evaluation/Management (E/M) CPT Codes and Billing Tips for Gastroenterologists
When submitting a claim with E/M codes, it’s important to clarify if the patient was new or returning to your practice.
- New patient: An individual who hasn’t received any services from a physician/non-physician practitioner (NPP) or any other physician of the same specialty who belongs to the same practice within the last 3 years.
- Returning patient: An individual who has received services from a physician/NPP or anyone else of the same specialty and who belongs to your practice within the last 3 years.
Furthermore, it’s important to know that you can bill based on time allotted or based on the complexity of your patient.
For time-based E/M medical billing, use these codes:
- 99202: 15-29 minutes
- 99203: 30-44 minutes
- 99204: 45-59 minutes
- 99205: 60-74 minutes
If billing based on complexity, use these CPT codes:
- 99212: Straightforward level of complexity, minimal risk or chance of complications (approximately 10-19 minutes)
- 99213: Low level of complexity, low risk or chance of complications (approx. 20-29 minutes)
- 99214: Moderate complexity, moderate risk, or chance of complications (30-39 minutes)
- 99215: High complexity, high risk, or chance of complications (40-54 minutes)
Transform Your Gastroenterology Billing with NCG Medical Billing Services!
Balancing your gastroenterology practice’s appointments, SOAP notes, billing and coding, all the while delivering top-quality care to your patients can be overwhelming. Save time, energy, and streamline your healthcare revenue cycle by bundling your practice management with outsourced gastroenterology insurance and Medicare billing from NCG Medical!
As an experienced EMR and insurance billing provider for gastroenterology practices, the medical billing experts here at NCG Medical can help your practice navigate the billing process to minimize denials and increase revenue. With a knowledgeable partner by your side, you can focus more on treating patients to help your gastroenterology practice grow rather than worrying about insurance billing.
