ACG ACG Practice Management 1 — Questions and Answers
Question 1: Which ACG resource helps gastroenterologists navigate coding and billing for endoscopic procedures?
- ACG Coding and Reimbursement Guide (Correct answer)
- ACG Research Grant Handbook
- ACG Fellowship Match Toolkit
- ACG Clinical Trials Registry
Correct answer: ACG Coding and Reimbursement Guide
ACG's Coding and Reimbursement resources provide guidance on CPT codes, billing practices, and reimbursement policies specific to gastroenterology procedures.
Question 2: What is the primary billing code used for a diagnostic colonoscopy in a Medicare patient?
- CPT 45380
- CPT 45378 (Correct answer)
- CPT 45385
- CPT 45384
Correct answer: CPT 45378
CPT 45378 is the standard code for diagnostic colonoscopy, used when no polyp removal or biopsy is performed during the procedure.
Question 3: Under the ACA's colorectal cancer screening provision, a screening colonoscopy that requires polypectomy is typically billed how for Medicare patients?
- As a purely diagnostic colonoscopy with no cost-sharing
- As a screening procedure converted to diagnostic, with potential cost-sharing implications (Correct answer)
- As a separate polypectomy only, not a colonoscopy
- As an outpatient surgery requiring separate facility coding
Correct answer: As a screening procedure converted to diagnostic, with potential cost-sharing implications
When a screening colonoscopy converts to a therapeutic procedure (polypectomy), cost-sharing requirements may apply under Medicare, though recent policy changes have reduced this burden.
Question 4: ACG's practice management resources address which regulatory framework that governs physician quality reporting?
- HIPAA Privacy Rule only
- MACRA/MIPS (Merit-Based Incentive Payment System) (Correct answer)
- Stark Law referral prohibitions
- FDA device approval pathway
Correct answer: MACRA/MIPS (Merit-Based Incentive Payment System)
MACRA/MIPS governs how physicians are evaluated and reimbursed under Medicare's quality reporting programs, directly affecting gastroenterologists' payments.
Question 5: What is the purpose of quality metrics like adenoma detection rate (ADR) in gastroenterology practice management?
- To determine physician salary levels
- To benchmark colonoscopy quality and guide performance improvement efforts (Correct answer)
- To set CPT code values for colonoscopy
- To calculate medical malpractice insurance premiums
Correct answer: To benchmark colonoscopy quality and guide performance improvement efforts
ADR is a key quality indicator that measures how often colonoscopists find adenomas, serving as a benchmark for colonoscopy quality and cancer prevention effectiveness.
Question 6: Which ACG initiative supports gastroenterologists in implementing quality improvement programs in their practices?
- ACG Quality Improvement Initiative (QI) (Correct answer)
- ACG Pharmaceutical Liaison Program
- ACG Medical Device Registry
- ACG Hospital Credentialing Protocol
Correct answer: ACG Quality Improvement Initiative (QI)
ACG's Quality Improvement programs provide tools, benchmarks, and resources to help practices measure and improve the quality of GI care they deliver.
ACG ACG Practice Management 1
Which ACG resource helps gastroenterologists navigate coding and billing for endoscopic procedures?