Understanding the Gastroenterology CPT Codes

With changing diets and lifestyles, people are vulnerable to digestive disorders, such as acid reflux and food poisoning, but rarely see a gastroenterologist. Due to these difficulties, billers must be proficient in gastrointestinal medical billing to get paid on time. Your gastroenterology clinic should strive for a 95% clean claims rate, meaning that most of your claims are accepted upon initial submission.

Yet, on average, most medical centers only achieve a 75%–85% error-free claims rate. Upper endoscopy, colonoscopy, and gastrointestinal tract biopsies are a few types of gastroenterology CPT codes.


Common Gastroenterology CPT Codes


CPT Diarrhea Codes in Gastroenterology

  • 2: Allergy and diet-related colitis and gastroenteritis
  • 89: Further specified non-infectious colitis and gastroenteritis
  • 7: Unspecified diarrhea

CPT Codes for Nonspecific or Many Site Abdominal Pain

  • 10: Unknown upper abdominal ache
  • 2: Perineal and pelvic discomfort
  • 30: Unknown lower abdomen pain

Gastroenterology Benign Neo Rectum/Anus Codes

  • 7: Neoplasm of the rectosigmoid junction that is benign
  • 8: Benign tumor of the rectum
  • 9: Healthy growth of the anus and anal canal

Flatulence, eructation, and gas CPT codes for gastroenterology

  • 0: Distension of the abdomen (gaseous)
  • 1: Painful gas
  • 2 Eructation
  • 3: Flatulence

CPT Codes for Benign Neo Lg Bowels

  • 0: Benign cecal neoplasm
  • 1: Appendix benign neoplasm
  • 6: Benign colonic neoplasm, unknown
  • 5: Colon polyp

The Crohn’s disease CPT codes

The chronic gastrointestinal tract inflammation associated with Crohn’s disease, also known as ileitis or regional enteritis, causes severe diarrhea, exhaustion, weight loss, malnutrition, and other symptoms.


  • 10: Large intestine Crohn’s disease without complications
  • 111: Large intestine Crohn’s disease with rectal haemorrhage
  • 112: Large intestine Crohn’s disease with intestinal obstruction
  • 113: Fistulous Crohn’s disease of the large intestine
  • 114: Large intestine Crohn’s disease with abscess
  • 118: Large intestine Crohn’s disease with another complication
  • 119: Large intestine Crohn’s disease with unknown complications

CPT codes for additional studies and tests in gastroenterology

See the following CPT codes for further gastrointestinal examinations, such as motility testing and manometry services:

  • 91010: Research on esophageal motility
  • 91020: Research on gastric motility
  • 91034: Tests for gastroesophageal reflux
  • 91035: Electrode-based test for gastroesophageal reflux
  • 91037: Electrode-based esophageal function test
  • 91038: Test of the esophagus, less than an hour
  • 91040: Tests for esophageal balloon dilation
  • 91065: Methane/hydrogen breath test
  • 91110: Gastrointestinal tract imaging and capsule endoscopy
  • 91111: Gastrointestinal imaging and endoscopy
  • 91112: Measurement of the GI using a wireless capsule
  • 91120: Rectal sensation examination
  • 91122: Manometry of the abdomen
  • 91200: Electrography of the liver
  • 91299: gastrointestinal treatment (other)

Gastroenterologists’ Billing Guidelines and Evaluation/Management (E/M) CPT Codes

When submitting a claim using E/M codes, it is essential to indicate whether or not the patient is a first-time visitor.

  • Patients who haven’t seen their NPP or another doctor in the same specialty from the same practice in the past three years are considered new patients.
  • A returning patient has visited your office during the last three years and has previously gotten care from a doctor, nurse practitioner, or someone with a related specialization.

In addition, it is crucial to understand that you might charge according to the period allocated or the intricacy of the patient’s case.


Use these codes for time-based E/M medical billing:

  • 99202: 15 to 29 min
  • 99203: 30 to 44 min
  • 99204: 45 to 59 min
  • 99205: 60 to 74 min

Use the following CPT codes for charging based on complexity:

  • 99212: Little complexity, little danger, or the possibility of difficulties (approximately 10-19 minutes)
  • 99213: Minimal risk, low potential for complications, and little complexity (approx. 20-29 minutes)
  • 99214: moderate risk, moderate difficulty, or the possibility of complications (30-39 minutes)
  • 99215: High risk, high complexity, or potential for complications (40-54 minutes)

Conclusion


Using the appropriate technique and careful coding is necessary for coding and billing for gastroenterology procedures or any healthcare service. To accomplish this, recruiting a group of experts with coding and billing knowledge is essential if you want to be paid accurately and on time.





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