Eligibility & Verification
Coverage checks before every visit.
Specialty Billing
Gastroenterology Medical Billing
GI billing centers on endoscopic procedures with tricky screening-vs-diagnostic rules. We apply the correct modifiers and split facility and professional billing so colonoscopies and endoscopies are paid right.
The Challenge
Gastroenterology billing, solved
We understand the billing complexities unique to gastroenterology and build them into every claim.
- Endoscopy and colonoscopy coding
- Screening vs. diagnostic modifiers
- Facility vs. professional billing
What we focus on
- Endoscopy procedure coding
- Screening modifier (PT / 33)
- Anesthesia coordination
Coding Focus
Gastroenterology code sets we work in
The CPT/HCPCS procedure families and ICD-10 diagnosis groups our certified coders handle for this specialty every day.
Common CPT / procedure codes
- 45378–45398Diagnostic and therapeutic colonoscopy procedures
- 43235–43259Upper gastrointestinal endoscopy of the esophagus and stomach
- 45330–45347Flexible sigmoidoscopy with optional intervention
- G0105 / G0121Medicare screening colonoscopy for eligible patients
ICD-10 diagnosis focus
- Z12.11 colorectal cancer screening encounter
- K50–K52 inflammatory and other colitis
- K21 gastroesophageal reflux disease
- K57 / D12 diverticular disease and colon polyps
Code references are shown as general identifiers for illustration. Actual code selection always follows current payer rules and your provider's documentation.
Clean Claims
Modifiers, denials & billing rules we manage
How our team keeps gastroenterology claims compliant — the modifiers that matter, the denials we prevent, and the guidelines we follow.
Key modifiers
- PT
Shows a screening colonoscopy that became therapeutic once a polyp was found.
- 33
Flags a preventive service so commercial cost-sharing is waived for the patient.
- 59
Separates distinct endoscopic techniques performed at different sites.
- 53
Reports a colonoscopy stopped before completion for a clinical reason.
Common denials & fixes
Patient billed cost-share on a screening that found a polyp.
Apply the screening-to-therapeutic modifier so preventive benefits still apply.
Anesthesia denied as not medically necessary.
Document sedation risk factors and coordinate the anesthesia claim with the procedure record.
Polypectomy techniques denied as bundled.
Report distinct removal methods with appropriate modifiers and separate site documentation.
Incomplete colonoscopy denied at full value.
Append the discontinued-procedure modifier and note why the exam could not be finished.
Billing guidelines
- Determine screening versus diagnostic intent up front, since a polyp found mid-procedure changes coding and cost-share.
- Append the screening-to-therapeutic modifier when a preventive exam becomes an intervention so the benefit is preserved.
- Coordinate anesthesia billing and confirm medical necessity for monitored sedation with the endoscopy team.
- Flag incomplete or aborted procedures immediately so the correct discontinued-service modifier is applied.
End-to-End
What we handle for Gastroenterology
A complete revenue cycle service tailored to your specialty.
Specialty Coding
Certified, specialty-trained coders.
Charge Entry & Claims
Clean, accurate claim submission.
Payment Posting
ERA/EOB posting and reconciliation.
Denial & AR Management
Appeals and aggressive AR recovery.
Reporting & Analytics
Real-time KPIs and insights.
98%
Clean claim rate
30%
Average revenue lift
24/7
Operations coverage
HIPAA
Compliant processes
FAQ
Gastroenterology billing — FAQs
Yes — our certified coders are trained on specialty-specific rules, code sets, and payer policies, and we assign coders with experience in your specialty.
We work in your current practice management system and EHR, so your workflows and reporting stay intact while we handle the billing.
Through accurate specialty coding, front-end eligibility checks, clean claim submission, and relentless denial and AR follow-up — typically lifting first-pass acceptance and net collections.
Always. We use strict access controls, encryption, signed BAAs, and audit trails to protect patient data.
More Specialties
Other specialties we bill for
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