Gastroenterology Billing Services
Gastroenterology billing centers on endoscopic procedures, and that’s where the coding gets complicated. A screening colonoscopy uses different codes than a diagnostic colonoscopy, and both use different codes than a therapeutic colonoscopy with polypectomy. The distinction between screening and diagnostic changes the patient’s cost-sharing, the code set, and the modifier requirements. Get it wrong and you’ve either under-billed or created a patient billing dispute.
We bill for GI practices performing hundreds of scopes per month. We understand the difference between hot snare and cold snare polypectomy codes, when to use the PT modifier for a converted screening colonoscopy, and how to capture all separately reportable interventions during a single endoscopic session.
Gastroenterology billing at a glance
Common gastroenterology procedures we bill daily.
Colonoscopy
Upper Endoscopy
Specialized Procedures
Gastroenterology billing challenges we solve every day.
Gastroenterology is one of the most complex specialties to bill. High-value procedures, strict documentation requirements, and frequent payer policy changes mean even experienced in-house billers miss revenue. For coding standards, see the American Gastroenterological Association.
Screening vs. diagnostic colonoscopy
A screening colonoscopy that becomes diagnostic (finding and removing a polyp) requires specific coding. The procedure started as a screening but ended as therapeutic. The PT modifier indicates a screening test converted to a diagnostic/therapeutic procedure. This affects patient cost-sharing under ACA rules. We code the conversion correctly so the patient isn’t incorrectly billed and the practice receives full reimbursement.
Multiple endoscopic interventions
When a colonoscopy involves multiple interventions (biopsy at one site, polypectomy at another, cautery at a third), each intervention may be separately reportable depending on the technique and location. CCI edits bundle certain combinations. We know which interventions report separately and which are bundled, maximizing reimbursement without triggering edit rejections.
ERCP coding complexity
ERCP procedures involve multiple potential interventions: sphincterotomy, stent placement, stone extraction, dilation, and tissue sampling. Each has its own code, and multiple codes can be reported in the same session. The coding depends on what was done, not what was planned. We code from the operative report, not the procedure order.
Anesthesia coordination
Most GI endoscopic procedures use moderate sedation or monitored anesthesia care (MAC). The coding for sedation depends on who administers it, who monitors the patient, and whether the facility or the physician bills for it. We coordinate with anesthesia billing to prevent duplicate charges and ensure both the GI and anesthesia services are captured correctly.
Full-service gastroenterology billing across your revenue cycle.
Simple, transparent gastroenterology billing pricing.
We also bill for these specialties.
Ready to fix your gastroenterology billing?
Schedule a free consultation. We’ll review your current billing performance, identify where you’re losing revenue, and build a plan to get your gastroenterology practice paid faster.
