Endoscopic procedures are medical services that are performed on patients through the use of an endoscope. The endoscope is a long tube with a camera at the end that displays views of a patient's digestive system and other organs. There are several types of endoscopy procedures therefore it is essential that the medical biller understand primary information about endoscopies. A physician will often perform more than one endoscopic procedure at a time, which can affect how Medicare reimburses the endoscopies.
Instructions
Find the Code
1. Identify the endoscopic surgical procedure code(s) in the patient medical chart and CPT Procedure Code book the provider wants to provide or has provided to the patient.
2. Verify that the physician provided diagnosis warrants medical necessity for the endoscopic procedure code using the ICD-9-CM Diagnosis book.
3. Determine if the physician billed one endoscopic procedure code or multiple endoscopic procedures on the same day. If provider billed one endoscopic procedure code, follow along and bill the single code appropriately. If you determine that the provider has billed multiple endoscopic procedure codes for the patient on the same day, further review the Medicare guidelines and other health insurance carriers' guidelines to determine if one or multiple codes should be billed. These multiple codes include diagnostic (x-ray) endoscopies and surgical endoscopies.
4. Determine if the multiple endoscopic procedure codes include those that are part of the same family. A family of codes is a group of endoscopic procedure codes that are similar in the area of the body or endoscopic procedure with minimal differences in how the scope was used with the patient (biopsy, brushing, washing, specimen collection). If there is a parent code, a code that represents the actual type of endoscopy and inclusive of the biopsy, washing, collection, etc, that includes the second endoscopic procedure code performed. Bill the parent code only.
5. Review the medical chart, diagnosis book, HCPCS manual and procedure book to determine if a modifier needs to be billed with the endoscopic procedure code.
6. Record the demographic data for the patient and provider, the health insurance member ID, health insurance address, diagnosis, procedures, charge amounts, etc. onto the HCFA 1500 form or other billing claim form.
7. Submit claim form to Medicare.
Tags: endoscopic procedure, endoscopic procedure code, procedure code, endoscopic procedure codes, health insurance