Screening frequency limit
Screening colonoscopies done before the allowed interval are denied.
How we prevent it: We check prior colonoscopy dates and risk level before scheduling.
GASTROENTEROLOGY BILLING
Gastroenterology Billing Services
GI billing involves endoscopy family coding, screening versus diagnostic colonoscopy rules, and modifiers that affect patient cost-sharing.
No upfront feesHIPAA-compliantSpecialty-trained coders
$0
Upfront or setup fees
0
Revenue cycle steps managed end to end
0
Specialties and lab types we bill for
0
Of your data and systems stay yours
OVERVIEW
Gastroenterology billing done right
GI billing involves endoscopy family coding and the difference between screening and diagnostic procedures. A screening colonoscopy that finds a polyp becomes therapeutic, which changes the codes, modifiers and patient cost sharing.
Endoscopy codes follow family rules, so multiple procedures through the same scope are reduced differently from unrelated procedures. Payers also apply screening frequency limits and require authorization for many EGDs and capsule studies.
We code GI procedures from the procedure and pathology reports, apply screening modifiers correctly so patients are not billed unexpectedly, and coordinate with anesthesia billing for sedation.
Also see our medical coding, denial management, eligibility verification and revenue cycle management services.
CODING
Common gastroenterology CPT & HCPCS codes we bill
GI procedure coding depends on whether a procedure is screening or diagnostic and on the technique used.
| Code | Description | What we watch for |
|---|---|---|
| G0121 | Colorectal cancer screening colonoscopy, not high risk | Medicare covers once every 10 years for average-risk patients. |
| G0105 | Colorectal cancer screening colonoscopy, high risk | Medicare covers once every 24 months for high-risk patients. |
| 45378 | Colonoscopy, diagnostic | Base code for the colonoscopy family. |
| 45380 | Colonoscopy with biopsy, single or multiple | Report once regardless of the number of biopsies. |
| 45385 | Colonoscopy with snare removal of tumors or polyps | Biopsy of the same lesion that is then removed is not billed separately. |
| 43235 | EGD, diagnostic | Base code for the upper endoscopy family. |
| 43239 | EGD with biopsy, single or multiple | Report once regardless of the number of biopsies. |
| 43249 | EGD with balloon dilation of esophagus, less than 30 mm | Diagnosis must support dilation, such as stricture or dysphagia. |
| 91110 | GI tract imaging, capsule endoscopy, esophagus through ileum | Usually requires prior authorization and prior endoscopy. |
| 91200 | Liver elastography, without imaging, with interpretation and report | Used for fibrosis assessment in liver disease. |
Code descriptions are summarized. CPT® is a registered trademark of the American Medical Association. Coverage and payment rules vary by payer and change every year; we code to the current code set and your payers’ policies.
Modifiers that matter in gastroenterology billing
PT
Screening turned diagnostic (Medicare)Used when a screening colonoscopy becomes diagnostic or therapeutic.
33
Preventive service (commercial)Shows a commercial plan that the procedure began as preventive screening.
KX
Follow-on screening colonoscopyMedicare uses KX for a colonoscopy after a positive stool-based test.
53
Discontinued procedureWhen a procedure is stopped for patient safety, such as poor prep.
59 / XS
Separate lesionFor different techniques on separate lesions in the same session.
DENIALS
Why gastroenterology claims get denied
The denial reasons we see most often in gastroenterology billing, with the claim adjustment reason code (CARC) payers usually attach, and what we do so they don't happen again.
Biopsy bundled with polypectomy
A biopsy and snare removal of the same polyp are bundled.
How we prevent it: Codes are assigned per lesion from the procedure report.
Screening diagnosis sequenced wrong
Screening claims need the screening Z code first, followed by findings.
How we prevent it: We sequence diagnoses per payer screening rules.
EGD or capsule study not authorized
Many plans authorize upper endoscopy and capsule studies.
How we prevent it: We submit authorization with symptoms and prior work-up.
Patient billed unexpectedly for screening
Missing PT, 33 or KX modifiers make screening procedures go to the deductible.
How we prevent it: We apply screening modifiers so preventive benefits are used.
HOW WE WORK
How we run your gastroenterology revenue cycle
From the first eligibility check to the final patient payment, one dedicated team handles every step and reports back to you.
01
Eligibility and authorization
We verify coverage, benefits, copays and deductibles before the visit. For GI, that includes screening eligibility, risk level and endoscopy authorizations.
02
Charge capture and coding
Our coders review documentation and assign CPT, HCPCS and ICD-10-CM codes to the highest supported specificity. Procedures are coded per lesion and technique from the procedure and pathology reports.
03
Claim scrubbing and submission
Every claim is checked against NCCI edits, payer policies and modifier rules before it goes out electronically, so it is paid on the first pass.
04
Payment posting and reconciliation
We post ERAs and EOBs, compare payments to your contracted rates and flag underpayments for appeal.
05
Denial management and A/R follow-up
Every denial is worked: corrected, appealed or escalated, with root causes fed back to the front end. Screening and bundling denials are reprocessed with corrected modifiers and reports.
06
Reporting and patient billing
You get clear monthly reports on collections, denials and A/R aging, and patients get easy-to-read statements and answers to billing questions.
COMPLIANCE
Gastroenterology payer rules we track for you
Rules that change how gastroenterology claims must be coded, documented and submitted.
Endoscopy family rules: multiple procedures through the same scope are paid based on the base code, not the standard 50% reduction.
Screening to diagnostic: Medicare uses modifier PT and commercial plans use 33 when screening turns therapeutic.
Follow-on colonoscopy: Medicare covers colonoscopy after a positive stool test as screening.
Anesthesia: payers differ on coverage of anesthesia for screening colonoscopy and require specific modifiers.
FAQ
Gastroenterology billing questions
How do you keep screening patients from getting surprise bills?
We apply PT, 33 or KX modifiers and sequence screening diagnoses correctly so preventive benefits apply.
Do you bill at ASCs and hospitals?
Yes. We bill professional fees at ASCs and hospitals and can also bill ambulatory surgery center facility fees.
Do you code from pathology results?
Yes. Pathology affects diagnosis coding and future screening intervals, so we code from final reports.
How much do your gastroenterology billing services cost?
We charge a percentage of what we actually collect for you, with no upfront or setup fees. Your rate depends on claim volume and the services you need, so we quote it after a free review of your current billing.
Do we have to change our EHR or practice management system?
No. We work inside the systems you already use, and your data stays yours. We set up secure access, learn your workflows and start working claims without disrupting your front desk.
Related specialties
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