Master 2025 Colonoscopy Updates: Coding, Billing and Payer Guidelines

Event Materials (Key Required)

We will discuss the billing and coding process for colonoscopy screenings and how it is essential for healthcare professionals who manage claims for both Medicare and non-Medicare patients. This comprehensive session focuses on the key differences in colonoscopy coding, ensuring accurate billing and optimizing reimbursements. During webinar, we will learn how to properly differentiate between preventive and diagnostic colonoscopies, along with the impact of patient risk levels on code selection.

We also discuss the important Medicare HCPCS codes, such as G0105 for high-risk patients and G0121 for average-risk screenings, emphasizing CMS compliance requirements. Also the key CPT codes used for non-Medicare billing will be highlighted, including 45378 for diagnostic procedures and 45380 for colonoscopies involving biopsies, clarifying their appropriate use and documentation requirements. Participants will understand how coverage criteria differ between Medicare and private insurers, impacting coding and reimbursement practices. The session will also share tips for avoiding common pitfalls that lead to claim denials, and best practices for maintaining thorough documentation to support accurate billing.

Learning Objectives:

• Understanding key differences between Medicare and Non-Medicare Codes
• Current billing and coding standards for colonoscopy screenings
• Differentiating between diagnostic and preventive colonoscopy procedures
• Medicare-specific rules and coding requirements for colorectal cancer screenings
• Learn how to accurately code for private insurers and non-Medicare payers
• Know the reimbursement rates and guidelines for different payers
• Common challenges and tips for avoiding claim denials
• Recent policy changes impacting reimbursement rates and guidelines
• Best practices for proper documentation to support coding decisions

Areas Covered in the Session:

• Visits Prior to a Colonoscopy
  • Evaluation and Management visits prior to Screening Colonoscopies
  • CMS Guidelines
  • S0285
• High Risk vs Non-Risk
• New Age Requirements
• The United States Preventive Services Task Force (USPSTF) Screening Recommendations
• Colon Anatomy
• Moderate Sedation Definition
• Types of Moderate Sedation for Colonoscopies
• Moderate Sedation Requirements
• Types of Colonoscopy Services by Definition
  • Screening
  • Surveillance
  • Diagnostic
  • Theraputic
• Exploring Sigmoidoscopy and Colonoscopy
• Sigmoidoscopy Key Factors
• Medicare/HCPC’s Codes for Sigmoidoscopy
  • G0104
  • G0106
• Medicare/HCPC’s Codes for Colonoscopy
  • G0105
  • G0120
  • G0121
  • G0122
• Colonoscopy CPT Codes – 45378, 45379 – 45398,
• Colonoscopy Decision Tree
• NCCI Edits and Medicare’s Coding Policy
• Colonoscopy Modifiers – 33, 52, 53, PT
• Denial Reason with Examples Questions

Suggested Attendees:

• Healthcare Administrators
• Physicians and Non-Physicians Providers
• Medical Coders
• Billing Specialists
• Gastroenterologists
• Clinic Managers
• Nurses
• Practice Manager
• Office Managers
• Revenue Cycle Staff
• Reimbursement Managers and Staff
• Policymakers
• Front Desk Staff
• Physicians in Private Practice
• Billing Staff and Companies
• Healthcare Consultants

Presenter Biography:

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Additional Information:

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

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Purchase Order Form – Click Here to download PO form.

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Snippet From Our Previous Session