Why Gastroenterology billing is different.
Gastroenterology billing expertise.
- Screening versus diagnostic colonoscopy coding
- Modifier PT and -33 for screenings converted to therapeutic
- EGD, ERCP and endoscopic ultrasound coding
- Biopsy, snare and ablation technique coding
- Multiple endoscopy payment rules
- Ambulatory surgery center and facility billing coordination
- Pathology-informed diagnosis coding
- Infusion billing for biologic therapies
Common Gastroenterology codes we work with.
| Code | Description |
|---|---|
45378 | Colonoscopy, flexible; diagnostic |
45380 | Colonoscopy, flexible; with biopsy, single or multiple |
45385 | Colonoscopy, flexible; with removal of tumor(s), polyp(s) or other lesion(s) by snare technique |
43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
G0105 | Colorectal cancer screening; colonoscopy on individual at high risk |
CPT® is a registered trademark of the American Medical Association. Codes shown are examples; correct coding depends on documentation and payer policy.
Our processGastroenterology billing process.
Scheduling and Eligibility
- Screening frequency and risk-level verification
- Prior authorization for advanced procedures
- Patient education on potential cost-sharing
- Facility and anesthesia coordination
GI Coding
- Screening, surveillance and diagnostic classification
- Technique coding for biopsies and polyp removal
- Screening modifiers when procedures convert
- Diagnosis sequencing for screening encounters
Claim Submission
- Scrubbing for endoscopy family edits
- Payer-specific screening rules
- Matching pathology to diagnosis codes
- Electronic submission within 24 hours
Denial Management
- Screening frequency denial appeals
- Corrected claims for modifier issues
- Patient balance disputes for screenings
- Underpayment recovery
Analytics
- Procedure volume by provider and site
- Screening versus diagnostic mix
- Payer reimbursement trends
- Denials by procedure type
Gastroenterology billing FAQs.
What happens when a screening colonoscopy finds a polyp?
The procedure becomes therapeutic, but it should still be identified as a screening for patient cost-sharing purposes. We use modifier PT for Medicare and modifier -33 for commercial payers where applicable.
How do you bill multiple techniques during one colonoscopy?
Each distinct technique, such as a biopsy and a snare polypectomy, can be coded, and payment follows the multiple endoscopy rules. We code each technique based on the procedure report.
How do you know if a patient is high risk for screening?
Risk is based on personal or family history, such as prior polyps or a first-degree relative with colorectal cancer. We verify the risk level and frequency limits before scheduling.
Do you bill for ambulatory surgery centers?
Yes. We coordinate professional and facility claims so both are coded consistently and submitted on time.