GI Practices Served
Clean Claim Rate
Revenue Recovered
Claim Submission
Gastroenterology billing revolves around procedural complexity. Endoscopic procedures carry bundling rules that change based on what the physician finds and treats during the procedure. A routine screening colonoscopy can escalate to a diagnostic procedure with polypectomy in minutes, and the billing must reflect each step accurately.
We handle GI billing with deep knowledge of endoscopy coding hierarchies, pathology specimen billing, and the ASC vs hospital outpatient facility distinctions that affect reimbursement. Every claim reflects the full scope of what was performed.
Every Gastroenterology billing team deals with payer delays, coding nuance, and collection leakage. We tighten those weak points before they turn into write-offs.
A screening colonoscopy (G0121) becomes a diagnostic colonoscopy with polypectomy (45385) when a polyp is found and removed. The billing must change mid-procedure, and the patient's cost-sharing responsibility shifts accordingly.
Multiple endoscopic techniques performed during the same session follow CCI bundling edits. Snare polypectomy, hot biopsy, and ablation each have specific rules about when they can be billed together and when modifier 59 is required.
The same colonoscopy reimburses differently depending on the site of service. ASC rates for screening colonoscopies follow specific Medicare payment rules, and incorrect place-of-service coding reduces reimbursement by 20% to 40%.
When specimens are collected during endoscopy, the pathology billing must coordinate with the procedure billing. Duplicate charges, missing specimen counts, and unlinked pathology reports create reconciliation problems.
Support spans the full revenue cycle, from front-end verification to denial recovery and reporting.
Endoscopy and colonoscopy procedure coding (45378-45398)
Screening to diagnostic colonoscopy conversion billing
ASC facility billing and Medicare rate optimization
Pathology specimen tracking and charge coordination
GI-specific modifier management (59, 76, 78)
Denial management for medical necessity and bundling issues
We support independent practices, multisite groups, and growing provider organizations with flexible workflows.
Independent physician groups
Multi-location practices
Private equity backed platforms
Hospital-owned outpatient groups
Gastroenterology billing revolves around procedural complexity. Endoscopic procedures carry bundling rules that change based on what the physician finds and treats during the procedure. A routine screening colonoscopy can escalate to a diagnostic procedure with polypectomy in minutes, and the billing must reflect each step accurately.
We handle GI billing with deep knowledge of endoscopy coding hierarchies, pathology specimen billing, and the ASC vs hospital outpatient facility distinctions that affect reimbursement. Every claim reflects the full scope of what was performed.
Answers to the questions practice owners and managers ask most often before switching billing partners.
When a screening colonoscopy converts to a diagnostic procedure with polypectomy, we bill the appropriate diagnostic code (45385 for snare removal, 45384 for hot biopsy). The patient's cost-sharing changes from preventive (no copay under ACA) to diagnostic, and we manage the patient communication about the billing change.
The top errors are incorrect colonoscopy code selection (screening vs diagnostic), failure to append modifier 59 for separately identifiable endoscopic procedures, unbilled pathology specimens, and incorrect place-of-service coding for ASC procedures.
Yes. We handle both the professional and facility components for GI-owned ASCs, including Medicare ASC payment rate calculations, supply charge capture, and the separate facility claim submission required for each procedure.
We reconcile the endoscopy report with pathology requisitions to ensure every specimen collected is billed, every pathology report is linked to the correct procedure, and no duplicate charges exist between the GI practice and the pathology lab.
Medicare ASC reimbursement for a screening colonoscopy with polypectomy is typically $600 to $900, while hospital outpatient rates range from $1,200 to $2,500 for the facility component. For physician professional fees, the rate is similar regardless of location.
When both upper endoscopy (EGD, 43235-43259) and colonoscopy (45378-45398) are performed in the same session, both procedures are billable. We apply the correct modifiers and ensure documentation supports the medical necessity for both procedures.
The difference is operational discipline. We focus on clean submissions, fast follow-up, and transparency.
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