includes all colonoscopy procedures coded 45378 through 45398,
though colonoscopy with a stent (45389) and colonoscopy using ultra-
sound-guided fine needle aspiration (45392) will see big jumps in
reimbursement this year.
One of the biggest drops includes proctoplasty procedures (45500
and 45505), which will drop 12.7% or an average decrease of $130.
And while the sigmoidoscopy family saw a few increases, most of the
codes in the category — including 45337, 45388, 45340, 45341, 45346,
45349 and 45390 — were cut about 7%, an average of $32 less per pro-
cedure.
While there are some increases this year, especially in upper endo-
scopic procedures, for the most part you'll be seeing cuts in reim-
bursement for your most common GI services. And while most of the
drops are slight, you still may want to focus on minimizing costs and
looking for additional opportunities to make up any missed revenue.
Focus on increasing efficiency while ensuring that patient safety is
still the No.1 priority. Improperly reprocessed flexible endoscopes
continue to be a problem that can have devastating financial conse-
quences, and one that has even shut down centers.
A good way to make up for the drop in revenue is to try to attract
patients who aren't Medicare beneficiaries. Since screening colono-
scopies starting at age 50 is the standard for preventative care, there are
still plenty of patients with commercial insurance plans. Negotiate con-
tracts with the big insurers in your area, if you haven't already.
Additionally, before scheduling any colonoscopy, make sure that
you verify the patient's insurance and confirm with the referring
physician's office whether the procedure is a diagnostic colonoscopy
or a screening one. (A reminder: Screening tests are given in the
absence of signs or symptoms, while diagnostic ones are tests per-
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