ED Coding & Reimbursement Alert - 2015 Issue 2
Physician Fee Schedule: Greet 10 'G' Codes for Lower GI Procedures
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Article Overview
This article covers a 2015 coding update affecting lower gastrointestinal endoscopy services and how Medicare reporting differs from reporting for other payers. It explains the CMS Physician Fee Schedule context, the need to reconcile older coding with revised CPT® 2015 code structure, and the use of HCPCS Level II alternatives for Medicare. The discussion is aimed at coders, billers, and physician practice staff who need to align reporting across payer types and settings.
Why This Topic Matters
The article matters because it addresses a payer-specific Medicare reporting issue during a major code revision, helping coding staff understand why the same procedure may require different reporting approaches depending on payer and site of service.
Article Sections
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Learn CMS’s Problem and Solution
Introduces the CMS payment context for the 2015 lower GI endoscopy update and outlines the broad reporting challenge created by the code revision. It also describes the general category of Medicare-specific alternatives discussed in the article.
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Take These Steps for 2015 Medicare Reporting
Summarizes the workflow differences between Medicare and non-Medicare reporting in 2015 and explains that the article provides a table to help compare related reporting choices. The section focuses on implementation issues for coding staff across payer types.
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Final caution
Notes that the payment treatment can differ between physician and facility billing contexts under Medicare. It highlights the broader need to distinguish reporting by setting as well as by payer.
What You Will Learn
- How the 2015 lower GI endoscopy code update affects Medicare and non-Medicare reporting
- How CMS Physician Fee Schedule guidance is relevant to these services
- How HCPCS Level II alternatives are used in the Medicare context
- Why physician and facility billing may require different reporting approaches
- How coding staff can compare current reporting with prior-year coding structure
Who Should Read This
- Physician coders
- Medical billers
- Practice managers
- Revenue cycle staff
- Compliance auditors
- Gastroenterology billing staff
Codes Discussed
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