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99%
Gastroenterology

Digestive health and endoscopy billing for GI clinics and ASCs.

Specialty highlight

99%

Built around payer rules, documentation requirements, and coding nuances.

Endoscopy Coding Accuracy

99%

Clean Claim Rate

97%

Overview

Billing in Gastroenterology

A practical view of what makes this specialty unique.

Gastroenterology billing is procedure-intensive, centered on endoscopic procedures like colonoscopy and EGD. It requires precise coding based on the procedure performed, any interventions (biopsy, polypectomy), and the patient's diagnosis and history (screening vs. diagnostic). Our gastroenterology billing service ensures accurate coding for all GI services, maximizing your revenue while navigating the complex rules for colorectal cancer screening coverage under Medicare and the Affordable Care Act.

Accurate coding for colonoscopy with and without biopsy/polypectomy.

Standardized into our workflow to reduce rework and protect revenue.

Expertise in billing for EGD with biopsy, dilation, or foreign body removal.

Standardized into our workflow to reduce rework and protect revenue.

Management of coding for ERCP and EUS procedures.

Standardized into our workflow to reduce rework and protect revenue.

Coding for anorectal manometry (91117) and Bravo pH monitoring (91034-91035).

Standardized into our workflow to reduce rework and protect revenue.

Challenges

What slows reimbursement

The common friction points that trigger delays, denials, and rework.

Key challenges
  • Accurately coding for screening vs. diagnostic colonoscopies and EGDs.
  • Ensuring proper coding for polypectomy based on the method (hot/cold snare, forceps) and number of polyps.
  • Billing for advanced endoscopic procedures (ERCP, EUS, endoscopic mucosal resection).
  • Managing the complexities of coding for Bravo pH studies, manometry, and other diagnostic tests.
  • Navigating Medicare's rules for waiving coinsurance for screening colonoscopies.
Our solutions
  • Certified GI coders with deep expertise in endoscopy coding and colorectal cancer screening guidelines.
  • Precise coding for all screening and diagnostic colonoscopies (45378-45398) and EGDs (43235-43270).
  • Expertise in coding for polypectomy based on method and number.
  • Meticulous coding for advanced therapeutic endoscopy procedures (ERCP 43260-43278, EUS 43231-43242).
  • Proactive management of medical necessity documentation for diagnostic procedures.
  • Detailed support for coding capsule endoscopy, breath tests, and other GI diagnostics.
Features

Operational features that keep claims clean

Repeatable checks, payer alignment, and tight charge capture.

Accurate coding for colonoscopy with and without biopsy/polypectomy.

Included to improve first-pass acceptance and reduce downstream edits.

Expertise in billing for EGD with biopsy, dilation, or foreign body removal.

Included to improve first-pass acceptance and reduce downstream edits.

Management of coding for ERCP and EUS procedures.

Included to improve first-pass acceptance and reduce downstream edits.

Coding for anorectal manometry (91117) and Bravo pH monitoring (91034-91035).

Included to improve first-pass acceptance and reduce downstream edits.

Compliance with Medicare and ACA guidelines for colorectal cancer screening.

Included to improve first-pass acceptance and reduce downstream edits.

Coding

Coding complexities we watch closely

Modifier usage, documentation rules, and specialty-specific payer edits.

Complexity checklist
  • Distinguishing between a screening (G0105, G0121) and a diagnostic (45378) colonoscopy.
  • Polypectomy coding based on the method (snare vs. forceps, hot vs. cold) and if it's a single or multiple.
  • Coding for control of bleeding (45382) and other therapeutic interventions.
  • Correct use of modifier -PT for colorectal cancer screening to indicate a screening converted to diagnostic.
Denial triggers

Incorrect coding for screening vs. diagnostic colonoscopy.

Billing for a screening with a diagnostic code (e.g., using Z12.11 for a polyp follow-up).

Unbundling of biopsy or polypectomy from the endoscopy code when appropriate.

Missing medical necessity for a diagnostic procedure.

Incorrect coding for the number of polyps removed.

Codes

Common codes (examples)

Reference-only examples to illustrate the typical coding landscape.

CPT

45380 (Colonoscopy with Biopsy), 45385 (Colonoscopy with Polypectomy), 43239 (EGD with Biopsy), 43235 (EGD), 91034 (Bravo pH)

ICD-10

Z12.11 (Screening Colonoscopy), K63.5 (Colon Polyp), K21.9 (GERD), R19.7 (Diarrhea), K50.90 (Crohn's)

FAQ

Frequently Asked Questions

Got questions? We've got answers

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