Medical Billing Guidelines for Gastroenterology Practices

May 18, 2021 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Gastroenterology

Gastroenterology practice

Gastroenterology practices have specific medical billing and coding challenges. Since this field requires both medical and surgical aspects, gastroenterology medical billing can be complex and necessitates an in-depth understanding of gastroenterology CPT codes.

This guide for gastroenterology medical billing best practices will help optimize your billing processes and boost your revenue cycle management!

Quick Links

What is Gastroenterology Medical Billing and Why Does it Matter?

Gastroenterology medical billing encompasses the related codes and practices of invoicing insurance companies for a patient’s gastroenterology procedure. Utilizing accurate medical coding ensures that insurers have all the diagnostic codes required for appropriate payment. Correct coding is also critical for demographic assessments and studies of disease prevalence, treatment outcomes, and accountability-based reimbursement systems.

Essentially, gastroenterology medical billing is important for the success of your organization and the community you serve.

Common Gastroenterology CPT Codes

There are nearly 72,000 ICD-10-CM codes to choose from, and it is often difficult to find the exact code when doing a search in the electronic health record and billing system. Staff education and training are essential to make the billing sector of your practice as efficient as possible when navigating medical codes.

Here are some common gastroenterology CPT codes to start with:

Diarrhea

K52.2 Allergic and dietetic gastroenteritis and colitis

K52.89 Other specified noninfective gastroenteritis and colitis

R19.7 Diarrhea, unspecified

Abdom Pain Ot/Multi Site

R10.10 Upper abdominal pain, unspecified

R10.2 Pelvic and perineal pain

R10.30 Lower abdominal pain, unspecified

Benign Neo Rectum/Anus

D12.7 Benign neoplasm of rectosigmoid junction

D12.8 Benign neoplasm of rectum

D12.9 Benign neoplasm of anus and anal canal

Flatulence Eructation/Gas

R14.0 Abdominal distension (gaseous)

R14.1 Gas pain

R14.2 Eructation

R14.3 Flatulence

Benign Neo Lg Bowel

D12.0 Benign neoplasm of cecum

D12.1 Benign neoplasm of appendix

D12.6 Benign neoplasm of colon, unspecified

K63.5 Polyp of colon

Crohn’s Disease

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 practice

Top Medical Billing Tips for Gastroenterology Practices

For the most optimized medical billing experience, here are some of the best practices for gastroenterology medical billing. 

1. Medical Billing is a Team Effort

The physician is responsible for accurate and specific documentation and bringing charges back to the billing staff for claim submission. Billing staff need to communicate any significant changes to the physicians or providers as these changes occur. Physicians and coding staff need to have an open line of communication to make sure that everything is submitted appropriately according to payer policies. 

2. Bill Appropriately for Evaluation & Management (E&M) Services

Evaluation and management services are the first steps taken for patients at any gastroenterological practice. Three criteria have to be met to support any initial visit with patients: the history obtained, the examination performed, and the development of the treatment plan. There are five levels of service for office visits and three levels for inpatient visits, respectively, so it’s important to select the most accurate level when billing.

3. Language for Diagnostic Studies

Medical necessity for testing must be documented in order to submit charges for diagnostic studies. Verbiage like “rule out” or “suspect” don’t completely give coders the reason why a physician suspects the patient might have a condition - usually, abnormal lab tests, signs, and symptoms will often warrant the need for further investigation, and these are the most crucial indications for testing. Make sure that the interpretation of the test results is clear along with a plan or recommendation for next steps.

Gastroenterology CPT Codes

Enhance Your Medical Billing Experience With NCG Medical!

NCG Medical understands billing can be rife with challenges and confusion. We’ve spent the past 40 years tailoring our medical billing services to meet the needs of many different specialties, including medical billing, revenue cycle management, credentialing, and more. Our gastroenterology insurance billing services can give you the medical billing expertise your practice needs to grow and thrive in today’s modern medical landscape. Contact our billing experts today and experience what NCG Medical can do for your revenue cycle management!

Subscribe to Our Blog

Stay in-the-know on trends, best practices, and news affecting the medical billing industry!