On September 5, 2018, the American Medical Association (AMA) released the 2019 CPT Code Set in an official press release. The main theme surrounding new codes, revised codes, and deleted codes is to increase specificity. This is a good time to understand what has changed and how it may affect your medical practice moving forward.
Gastroenterology billing and coding are both complex and challenging, and perhaps nothing else has such a huge impact on your revenue cycle. Accurate, efficient billing and coding can accelerate your billing cycle and increase revenues, while mistakes in this area can result in lost revenues due to paybacks, denials, and under-coding.
Some of the new GI billing and coding changes for 2019 include:
Acute appendicitis with generalized peritonitis (changes for greater specificity)
- K35.20 – Acute appendicitis with generalized peritonitis, without an abscess
- K35.21 – Acute appendicitis with generalized peritonitis, with an abscess
Acute appendicitis with localized peritonitis (changes for greater specificity)
- K35.30 – Acute appendicitis with localized peritonitis, without gangrene or perforation
- K35.31 – Acute appendicitis with localized peritonitis and gangrene, without any perforation
- K35.32 – Acute appendicitis with perforation and localized peritonitis, without an abscess
- K35.33 – Acute appendicitis with perforation and localized peritonitis, with an abscess
Ischiorectal abscesses (changes for greater specificity)
- K61.31 – Horseshoe abscess
- K61.39 – Other ischiorectal abscess
- K80 Cholelithiasis Series (some new instructions
Use additional code if it is applicable for any associated gallbladder gangrene (K82.A1), or gallbladder perforation (K82.A2)
Disorders of the gallbladder in diseases classified elsewhere (there are new codes)
- K82.A1 – Gangrene of the gallbladder in cholecystitis
- K82.A2 – Perforation of the gallbladder in cholecystitis
Gastroenterology CPT Codes
2018: Gastroenterology CPT Codes |
2019: Gastroenterology CPT Codes |
| 43760 Change Gastrostomy Tube Percutaneous w/o Guidance | 43762 Replacement Of Gastrostomy Tube, Percutaneous, Includes Removal, When Performed, Without Imaging Or Endoscopic Guidance; Not Requiring Revision Of Gastrostomy Tract |
| 43763 Replacement Of Gastrostomy Tube, Percutaneous, Includes Removal, When Performed, Without Imaging Or Endoscopic Guidance; Not Requiring Revision Of Gastrostomy Tract |
Gastroenterology HCPCS Codes
2018: Gastroenterology HCPCS Codes |
2019: Gastroenterology CPT Code |
| No Code in 2018 | Q5103 Injection, Infliximab-dyyb, Biosimilar (Inflectra), 10 Mg |
| No Code in 2018 | Q5104 Injection, Infliximab-dyyb, Biosimilar (Renflexis), 10 Mg |
| No Code in 2018 | Q5109 Injection, Infliximab-qbtx, Biosimilar (Ixifi), 10 Mg |
With so many complexities and regular billing and coding changes, gastroenterology practices often benefit from help from an expert. Outsourcing your GI billing and coding to a quality medical billing company that has experienced, certified professionals can help your practice ensure clean claim submission in order to reduce denials and maximize your practice revenue.
MBC specializes in GI billing and coding, works with all practice management software, and can provide your practice with the accuracy needed to keep the revenue cycle moving while increasing revenues.
To learn more about how we can help your gastroenterology practice deal with billing challenges and improve revenue, contact MBC today.
FAQs
The 2019 CPT code set introduced greater specificity, with updates to codes for acute appendicitis, gallbladder disorders, and ischiorectal abscesses. These changes help improve the accuracy of diagnoses and treatment coding.
New codes for acute appendicitis, such as K35.20 and K35.21, provide more detailed classifications based on the presence of peritonitis and abscesses. This leads to more accurate billing and potentially higher reimbursement.
The 2019 HCPCS code set added new codes for biosimilar injections, such as Q5103, Q5104, and Q5109, for medications like Infliximab-dyyb (Inflectra) and Infliximab-qbtx (Ixifi), which help streamline billing for these treatments.
By increasing coding specificity, the new codes help reduce billing errors, leading to fewer denials and faster claim processing. This can help your practice improve revenue by ensuring accurate reimbursements.
Outsourcing to a specialized medical billing company can ensure clean claims, reduce denials, and maximize revenue. Expert coders are up-to-date with the latest code changes and can handle the complexities of gastroenterology billing.
