ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month ASGE gets dozens of questions from members. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Full patient and practice information is a violation of HIPAA privacy rules and questions will be sent back without an answer. Here are three coding tips to help you and your practice optimize your reimbursement.
Tip #1
G codes in the Healthcare Common Procedure Coding System (HCPCS) G0121 (average risk screening colonoscopy) and G0105 (high risk screening colonoscopy) should be billed when it is time for the patient's screening or surveillance colonoscopy and results with normal findings (no therapeutic intervention required). Medicare has covered these two HCPCS codes for many years, however, these codes are not just for Medicare. Many commercial payers also cover the G-codes and have them listed in their screening colonoscopy policies - United Healthcare, Cigna, Aetna, Anthem, Blue Cross Blue Shield - to name a few.
Tip #2
If you are receiving denials for ICD-10-CM diagnosis code Z86.010 as "not a primary diagnosis", try submitting the claim with Z09 as primary, followed by Z86.010. Per ICD-10 guidelines, code first any follow-up examination after completed treatment (Z09).
Tip #3
When performing an audio-only (no video) telehealth visit with a patient, make sure time spent on the call is documented in the clinical encounter. Most insurance companies accept the audio-only CPT code range 99441-99443 which are solely based on time. Time spent is the patient and provider on the call and not time spent by medical staff.