Moderate Sedation for "gastrointestinal endoscopic service" G0500

TKoehn

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Confused on the CPT text under the G0500 -- says it's specifically for "gastrointestinal endoscopic service". So when billing for colonoscopy and EGD can we only bill the G0500 for moderate sedation or can we bill the 99152 if they are not Medicare patients? Most of the documents I find says the G0500 is only for Medicare but I found an article that indicates G0500 is for all payers and GI endo procedures ONLY, meaning the other codes will not be reimbursed for GI endoscopes. THEN I noticed the wording in 99152 is "diagnostic or therapeutic service that the sedation supports" and not the phrase referenced earlier (gastrointestinal endo service) for G0500.

Hope this makes sense, any input would be appreciated. I don't want to bill the 9915x initial code to commercial and have them take money back, as I noted the fee schedule is different for ME so probably different for everyone else.

Thank you so much! Super grateful for the opportunity to ask on this forum
-Tif:D
 

TKoehn

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I am probably over thinking this, because of all the information I have read in such a short amount of time...BUT any input would be awesome. Thank you again - Tif
 

CodingKing

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Its going to depend on the payer. G codes can be used for commercial. Many commercial payers follow CMS guidelines.
 
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Intra service time for moderate sedation

As like you I'm reading so much information in such a short time, I'm confused on the intra-service time. Cpt book states it is when the provider administers the sedation agent to when the providing physician ends personal contact but in the Gastroenterology coding alert it states it as "scope in to scope out"??? Any info would be helpful. thanks
 

rsmith1

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RSmith1

We at our clinic is also trying to figure out if we should have our GI providers document "scope in and scope out" in their op-notes. Or should be having them document "start time and stop time". Any answer would help.
 
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