Gastroenterology Coding Alert

Question: We have been getting denials from Medicaid and other insurance companies for procedures that our gastroenterologist performed. They are stating that the amount has been paid out to the hospital where our gastroenterologist performed the procedure. Is the hospital billing wrong? Please tell me what codes should I bill out such that we get paid for the procedures that our gastroenterologist performed?Colorado SubscriberAnswer: When your gastroenterologist performs any procedure in the hospital setup, you can claim reimbursements for the procedure performed by using the appropriate CPT® codes. For example, if your gastroenterologist performed a diagnostic EGD, you can bill out 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) to get appropriate reimbursements from the concerned insurance carrier.The hospital on its part cannot claim the same CPT® code for the [...]