Gastroenterology CPT Codes and Tips for 2023


Gastroenterology CPT Codes and Tips for 2023

Date Posted: Sunday, March 19, 2023


Since gastroenterology practices can perform both medical and surgical services, your gastroenterology medical billing strategy has to take this into account. Billing for this specialty can be challenging, but the friendly experts at NCG want to make it simple for you to boost your healthcare revenue cycle.

The following is a handy list of commonly used gastroenterology CPT codes so that you and your staff can quickly find what codes you're looking for. Keep reading to learn the importance of using accurate gastroenterology CPT codes and more!

The Importance of Accurate Gastroenterology CPT Codes

An optimized healthcare revenue cycle means all components are as efficient as possible and that you don't have to go back and redo the same thing over and over again. A cornerstone of such an efficient process is using accurate medical billing codes.

There are thousands of medical billing codes to correspond to thousands of healthcare procedures, tests, and services – so there's no wonder why it can be a complicated process. Medical practices that submit inaccurate codes then have to deal with rejected claims. Reworking claims means spending unnecessary time and effort on something that ideally was done correctly the first time around.

To put it in perspective, your gastroenterology practice should have a clean claims rate of 95%, meaning that 95% of your claims are processed successfully on the first submission. Most practices fall a little short of this and have an average clean claims rate of 75%-85%.

Let's say each claim costs $25 to rework and you have an average 100 claims that need to be reworked each month – that adds up to a hefty $2,500 a month and $30,000 per year! One essential step you can take to avoid these costs is to ensure each claim uses the correct gastroenterology CPT codes.

Gastroenterology CPT codes are essential for your healthcare revenue cycle!

Frequently Used Gastroenterology CPT Codes

These medical billing codes are essential for your gastroenterology practice in 2023:

Gastroenterology CPT Codes for Diarrhea

K52.2 - Allergic and dietetic gastroenteritis and colitis
K52.89 - Other specified noninfective gastroenteritis and colitis
R19.7 - Diarrhea, unspecified

Abdominal Pain Ot/Multi Site CPT Codes

R10.10 - Upper abdominal pain, unspecified
R10.2 - Pelvic and perineal pain
R10.30 - Lower abdominal pain, unspecified

Benign Neo Rectum/Anus Gastroenterology Codes

D12.7 - Benign neoplasm of rectosigmoid junction
D12.8 - Benign neoplasm of rectum
D12.9 - Benign neoplasm of anus and anal canal

Gastroenterology CPT Codes for Flatulence Eructation/Gas

R14.0 - Abdominal distension (gaseous)
R14.1 - Gas pain
R14.2 - Eructation
R14.3 - Flatulence

Benign Neo Lg Bowel CPT Codes

D12.0 - Benign neoplasm of cecum
D12.1 - Benign neoplasm of appendix
D12.6 - Benign neoplasm of colon, unspecified
K63.5 - Polyp of colon

CPT Codes for Crohn's Disease

Crohn's Disease, also known as ileitis or regional enteritis, involves chronic inflammation of the digestive tract that results in abdominal pain, severe diarrhea, fatigue, weight loss, malnutrition, and more.

K50.10 - Crohn's disease of large intestine without complications
K50.111 - Crohn's disease of large intestine with rectal bleeding
K50.112 - Crohn's disease of large intestine with intestinal obstruction
K50.113 - Crohn's disease of large intestine with fistula
K50.114 - Crohn's disease of large intestine with abscess
K50.118 - Crohn's disease of large intestine with other complication
K50.119 - Crohn's disease of large intestine with unspecified complications

Gastroenterology CPT Codes for Other Studies and Tests

Check out these CPT codes for other gastroenterology studies and tests, including motility tests and manometry services:

91010 - Esophagus motility study
91020 - Gastric motility studies
91034 - Gastroesophageal reflux tests
91035 - Gastroesophageal reflux test with electrode
91037 - Esophageal function test with electrode
91038 - Esophageal function test, less than 1 hour
91040 - Esophageal balloon distention tests
91065 - Breath hydrogen/methane test
91110 - GI tract imaging, capsule endoscopy
91111 - GI tract imaging, esophageal endoscopy
91112 - GI wireless capsule measurement
91120 - Rectal sensation test
91122 - Anorectal manometry
91200 - Liver electrography
91299 - Gastroenterology procedure (other)

Evaluation/Management (E/M) CPT Codes and Billing Tips for Gastroenterologists

When submitting a claim with E/M codes, it's important to clarify if the patient was new or returning to your practice:

New patient: An individual who hasn't received any services from a physician/non-physician practitioner (NPP) or any other physician of the same specialty who belongs to the same practice within the last 3 years.

Returning patient: An individual who has received services from a physician/NPP or anyone else of the same specialty and who belongs to your practice within the last 3 years.

Furthermore, it's important to know that you can bill based on time allotted or based on the complexity of your patient.

For time-based E/M medical billing, use these codes:

99202 - 15-29 minutes
99203 - 30-44 minutes
99204 - 45-59 minutes
99205 - 60-74 minutes

If billing based on complexity, use these CPT codes:

99212 - Straightforward level of complexity, minimal risk, or chance of complications (approximately 10-19 minutes)
99213 - Low level of complexity, low risk, or chance of complications (approximately 20-29 minutes)
99214 - Moderate complexity, moderate risk, or chance of complications (30-39 minutes)
99215 - High complexity, high risk, or chance of complications (40-54 minutes)

Transform Your Gastroenterology Billing with NCG Medical Billing Services!

Balancing your gastroenterology practice's appointments, SOAP notes, billing and coding, all the while delivering top-quality care to your patients can be overwhelming. Save time, energy, and streamline your healthcare revenue cycle by bundling your practice management with outsourced gastroenterology insurance and Medicare billing from NCG Medical!

As an experienced EMR and insurance billing provider for gastroenterology practices, the medical billing experts at NCG Medical can help your practice navigate the billing process to minimize denials and increase revenue. With a knowledgeable partner by your side, you can focus more on treating patients to help your gastroenterology practice grow rather than worrying about insurance billing.

By The Next Generation of Medical Billing & RCM - Practice Management

Since 1979, our team at NCG Medical has made it our mission to function as a part of your practice, taking billing off of your administrative team's plates and freeing up your talented team for what's most important—your patients. We'll consult with your team to provide custom solutions that are right for your practice.


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