2023 Colonoscopy Coding and Billing Updates: Payer Guidelines Matter

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We will discuss different types of Colonoscopy procedures and reimbursement strategies. In 2023 with the recent updates to patient coverage, it will be imperative that practices and facilities understand how the reimbursement will affect them. We will show you tips for Prior Authorization and make sure you understand coverage and documentation requirements.

We will review the common billing errors made when billing for Colonoscopy procedures. We will discuss the Payer Guidelines for Commercial vs CMS Guidelines and proper Modifier Usage. Many payers require a specific order of Diagnosis code sequencing and misinterpreting these guidelines can lead to costly denials.

We will review several examples as well of therapeutic colonoscopy vs diagnostic. How do you interpret which modifier to use for which payer when a Colonoscopy becomes surgical when a Screening was intended? Does the code change according to the depth of the scope?

We will need to discuss proper understanding of the anatomical structure of the Large Intestine and the official CPT guidelines in order to properly code these procedures. We hope this presentation will help increase your revenue and decrease your denials in Colonoscopy Billing and Coding

Learning Objective:

  • Learn how to avoid Costly Billing Denials
  • Learn to Interpret which modifiers to apply
  • Identify the proper anatomical structures
  • Coding Guidelines for CMS
  • Coding Guidelines for CPT
  • Proper ICD10-CM Sequencing
  • Documentation Requirements

Areas Covered in the Session

  • Screening vs Diagnostic
  • Coverage Guidelines for Surveillance Colonoscopy
  • Learn the different colonoscopy techniques and documentation
  • Proper Modifier use explained
  • LCD policies that affect Colonoscopy reimbursement
  • Prior Authorization Tips
  • How the CMS Final Rule affects patients and Physicians
  • Colon Anatomy
  • Preventative Services
  • Surgical Techniques
  • Modifier Quick Tips
  • Mastering PA approvals
  • Coverage and Benefits in 2023
  • ICD10 CM Order and LCD policies

Suggested Attendees

  • Clinic Managers
  • Hospital Director
  • Software Developers
  • Coders
  • Billers
  • Physicians
  • Nurses
  • Hospital Administrators
  • ASC Directors
  • Mid-Level Providers
  • Reimbursement managers and staff
  • Office Managers
  • Compliance officers

About the Presenter

Jennifer McNamara, CPC, CPC-I, CRC, CGSC, COPC, AAPC Approved Instructor serves as the Director of Education and Coding for Oncospark. She brings impact and results with 20+ years of proven healthcare revenue cycle experience and effective instruction. She has embraced the changes in the billing and coding space by embracing the movement to value-based care and software deployment across specialties. Jennifer and her team of Subject Matter Experts are committed to teaching others the intricate world of billing and coding and the future of the Healthcare space.

Jennifer started her career in 2000 and has worked in many specialized areas of Coding including Orthopedics, Plastic Surgery, General Surgery, Ophthalmology, Podiatry, and many more. The coding team at Oncospark provides Auditing, Consulting, RCM services, Credentialing, and Compliance through our team of experts.

Jennifer is the host of the popular podcast “Healthcare Crossroads” showcasing the connections in Healthcare Data, Compliance, and Patient Care.

Course Content

You can access all the webinar materials after successful payment

  • Webinar Link + Handouts PDF
  • Course Key
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