2015-08-05 13:04:01 UTC

United Healthcare Releases New Payment Rule, ICD-10 Guide for GIs

Aug. 5, 2015

On Nov. 15, 2015, United will begin using the CMS special multiple endoscopic reduction rules on commercial claims when multiple procedures are performed on the same date of service.

United Healthcare’s August 2015 bulletin announced major changes to the way GI procedures are reimbursed. 

Beginning Nov. 15, 2015, United will use the CMS special multiple endoscopic reduction rules on specific commercial claims. When multiple endoscopic procedures from the same endoscopic family are reported on the same day, United will allow the full allowable amount for the highest valued endoscopy code in the family.

It will also allow additional endoscopy codes in the same family at a reduced amount based on the value of the Physician Fee Schedule-designated base endoscopy code.

The current multiple surgery reduction rule will continue to apply to endoscopy codes from different families (e.g., EGD and colonoscopy) when reported on the same date of service. The primary procedure will be reimbursed at 100 percent, a 50 percent reduction is applied to the secondary procedure and, except in limited circumstances, a 25 percent reduction is applied to all subsequent procedures. 

United also developed the Physician ICD-10 Coding Practice Tool for physicians and their office staff to practice selecting ICD-10 codes for various clinical scenarios across 35 medical specialties, including GI. Each clinical scenario for commonly-used diagnosis codes includes a medical example, medical history and office notes, and users can compare codes used by peer physicians within each specialty.

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