Tag: Coding

09 Apr 2016

Our latest updates on Becker’s ASC


1. NextServices Showcases Solutions at Digestive Disease Week 2014
(GI Endoscopy-Driven Surgery Centers to Know 2013) NextServices announces endoscope integration with enki EHR at DDW 2014.
2. How Do GI Coding Changes Affect the Field? Reimbursement, Technology, Denials & More 
(ASC Coding, Billing and Collections) Praveen Suthrum, president and co-founder of NextServices, explains what the 2014 changes mean for gastroenterologists and GI-driven ambulatory surgery centers.
3. How to Boost Clean Claims Submission at ASCs 
(ASC Coding, Billing and Collections)Nextservices blog post outlined on how ambulatory surgery centers can achieve 95 percent clean claims submission ratio.

4. Sending Patient Statements: Tips From NextServices 
(News & Analysis) In a recent blog, NextServices provided the most effective methods for sending patient statements in order to see results.
5. 11 Esophagoscopy Code Updates to Know 
(ASC Coding, Billing and Collections) Gastroenterology coding changes.
6. Collect From Patients: Best Practice for Sending Statements 
(News & Analysis)NextServices recently posted an article about sending patient statements on their blog. The article discusses whether providers should send patient statements daily or in bulk.
7. NextServices Exhibits EHR Through Google Glass 
(News & Analysis) NextServices announced it has unveiled the prototype for enki Glassware at FutureMed in San Diego.
8. Futuristic Healthcare: 7 Considerations for Ambulatory Surgery Centers 
(ASC Turnarounds: Ideas to Improve Performance) Praveen Suthrum, president and co-founder of NextServices provides a look ahead for ambulatory surgery centers.

09 Apr 2016

Focus and cut costs to thrive in Ambulatory Surgery Center market

Focus and cut costs

Since 2010, the ambulatory surgery center (ASCs) market has neither grown nor declined. ASCs start, shut-down and acquire other ASCs. There are over 5,400 surgery centers. Available physicians are limited and hospitals continue to pose a strong competition – sometimes partnering with ASCs. According to arecent Becker’s ASC article, ASCs will need to excel in a single specialty and run a very low cost center model to sustain in the future.


There are three dominant specialties in the ASC market: orthopedics, gastroenterology and ophthalmology. Let’s the example of ASC centers focused on gastroenterology. As medical science advances and a greater number of newer procedures become eligible for insurance reimbursement, gastroenterologists must develop deeper focus within the specialty. In 2014, there are 26 new codes for gastroenterology – suggesting newer ways to focus, get reimbursed and build expertise. A group must focus on EUS, another on EGD or esophagoscopy and so on. This method of divide and conquer would allow an ASC to be known as a leader in the field within their market and at the same time cover a wide range of procedures within the specialty.

ASCs can further add plans that involve diet and exercise, virtual follow-ups for a monthly fee. This creates additional revenue streams based on deeper understanding of patients and their conditions. It also engages patients and their families better and brings them back to the center on a regular basis.

Cut costs

Outsourcing activities or tasks in a controlled and methodical manner is clearly a way to bring costs of administrative tasks down. Identify tasks that are lower on the complexity scale and delegate and outsource them. When they aren’t core to the business model (i.e., treating patients), tasks such as billing, coding, denial management, patient collections, accounting, credentialing, pre-authorizations and so on will tend to be distractions from the core focus of the surgery center. Outsourcing companies centralize operations for a large number of providers, giving them benefits of scale – these cost savings are typically passed on to the center that could then pass them on to patients.

According to the ASC Value Driver Survey, 24% of ASCs experience stable volume, 27% reported growing volume and 27 percent declining volume. In the same survey, respondents cited competition from other ASCs and hospitals as one of their biggest challenges. Clearly, it’s a time to focus and cut costs to stay competitive.

09 Apr 2016

How to code for optical endomicroscopy? (an optical biopsy)


What is it?

This technique involves use of optical technology to see enlarged view of cell, tissues in real time. It is also called Optical Biopsy. The doctor uses a probe, which is used to view the cellular structures in the organ concerned. It is found to be useful in:

  1. Barrette’s esophagus in detecting dysplastic lesions.
  2. In early detection of gastric cancer and intestinal metaplasia.
  3. Detection of malignant bilio-pancreatic strictures.
  4. Diagnosis of pancreatic cysts.
  5. Inflammatory bowel disease.
  6. Helps to differentiate between neoplastic and non neoplastic tissue.
  7. Detecting residual neoplasia after concerned tissue removal.


The year 2013 saw the allocation of two CPT codes: 

43206 – Esophagoscopy with optical endomicroscopy.

43252 – EGD with optical endomicroscopy.

These procedures cannot be reported with other endoscopy procedures. They are reported as separate and distinct procedures.


43206 and 43252 attracted an average payment of $149 & $186 respectively in a facility setting.

09 Apr 2016

What does it mean that 25% of ALL coding changes are related to Gastroenterology?


American Medical Association (AMA) added 175 new codes, revised 107 CPT/ procedure codes this year – 25% of them are related to gastroenterology (26 new codes, 41 revised codes and 17 deleted codes). Let’s consider an example.

If a patient showed up with a tumor in her esophagus, a gastroenterologist typically performs an esophagoscopy using snare technique to remove the tumor. A new technique has been doing the rounds during the past few years called Endoscopic Mucosal Resection (EMR) – it uses a suction mechanism to yank the tumor out from the skin before it’s cut. The technique helps in controlling unnecessary bleeding. Up until this year, EMR had no code. But this year, AMA recognized it with  43211 – a new code.

Up until this year, it didn’t matter whether a gastroenterologist used a flexible/ rigid scope or went in through the nose/ mouth during an esophagoscopy. But with the coding changes, it matters now – there’s increasing specificity.

What do examples of such coding additions/ changes mean for gastroenterology? At a very broad level, it simply means that there’s a shift underway. The patients are the same, the disease conditions are similar but how something can be diagnosed and treated is actively undergoing a change. Ambulatory surgery centers consider traditional upper and lower GI procedures as their bread and butter. But with steady innovation, better understanding and wider spread of newer techniques, the specialty will become even more specialized. Traditional procedures will continue to see declining reimbursements.

Knowing what we know of medicine, as procedures become mainstream, reimbursements decline and newer techniques become the preferred approach. It may be entirely possible that EMR may replace traditional esophagoscopy in the future. What if enough artificial intelligence algorithms may be built in to identify polyps from a video produced by a Video Capsule Endoscopy? What if the algorithms identify all possible polyps big and small throughout the digestive tract? Such thorough and extreme accuracy would be impossible with traditional colonoscopy that involves human hands and eyes. What would happen then to doctors who are not used to learning or experimenting with new procedures?

It’s also expected that in 2015, there would be lower gastroenterology coding changes. These coding changes are simply an acceptance of newer methods to treat and fix conditions and also a gentle nudge to gastroenterologists to stay current in their fields.

By Praveen Suthrum, President & Co-Founder, NextServices

09 Apr 2016

Esophagoscopy coding changes in 2014


Upper gastroenterology coding has seen important changes since Jan 1, 2014 – particularly, esophogoscopy procedures. Separate codes have been introduced for rigid esophagoscopy and flexible esophagoscopy.

Six new procedure codes have made an entry for rigid esophagoscopy this year. However, these codes are to be used only when esophagoscopy is done via the transoral route. In 2013, there were no separate codes for rigid transoral esophagoscopy – rigid or flexible esophagoscopy were included under the same definitions. In 2014, the specificity has increased based on the route of administration of scope i.e., transoral or transnasal and on whether the scope used was flexible or rigid.

If a rigid scope was used, the following new codes may be applied for the transoral route:

43191 – Rigid transoral e1sophagoscopy, diagnostic, brushing and washing. By using rigid scopes, procedures such as submucosal injections, biopsy, foreign body removal, balloon dilation, guide wire insertion and dilation over guide wire can be performed. CPT codes from 43192 through 43196 have been created to be used for these procedures.

If a flexible scope is used, but the route of administration is transnasal, these codes may be used:

43197 – Flexible transnasal esophagoscopy, diagnostic, brushing washing.

43198 – Flexible transnasal esophagoscopy, with biopsy.

Certain terminologies with respect to esophagoscopy have been revised. For e.g. CPT code 43200 is defined as ‘flexible’ (in 2014) as against ‘rigid or flexible’ (in 2013). CPT codes from 43200 through 43232 are now termed as flexible. The other specifications of the code descriptor remain the same.

New codes for Flexible Transoral Esophagoscopy

43211 – Flexible transoral esophagoscopy, mucosal resection. Till 2014, esophageal mucosal resection was reported by using unlisted codes 43499 (unlisted procedure, esophagus).

43212 – Flexible transoral esophagoscopy, stent placement, dilation and guide wire passage.

A new concept has been introduced, flexible transoral esophagoscopy with retrograde dilation with CPT code 43213.

43214 – Flexible transoral esophagoscopy, balloon dilation, including imaging. The imaging has been included effective 2014. Till 2014, imaging if performed had to be separately reported.

43229 – Flexible transoral esophagoscopy, with ablation, dilation and guide wire passage. This code now includes balloon dilation (43220), insertion of guide wire (43226) and ablation (43228).

By Sandeep Paranjape, Clinical and Coding expert, NextServices

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