Gastroenterology Billing Experts
Maximize your GI practice and endoscopy center revenue with specialized billing for colonoscopies, upper endoscopy, ERCP, and therapeutic procedures. Expert coding, modifier optimization, and ASC facility fee management.
GI Billing Services
- Colonoscopy & Endoscopy Billing
- ERCP Component Optimization
- Polyp Removal Documentation
- ASC Facility Fee Management
- Pathology Coordination
- Screening vs Diagnostic Coding
Industry-Leading GI Billing Performance
Our specialized gastroenterology billing outperforms industry benchmarks
Gastroenterology Billing Challenges We Solve
Complex endoscopy coding requires specialized GI billing expertise
Endoscopy Procedure Bundling
Colonoscopies, upper endoscopies, and ERCPs involve complex bundling rules. NCCI edits automatically bundle diagnostic endoscopy with therapeutic procedures. Proper modifier usage (59, 51) is critical to prevent denials.
Improper bundling costs average GI practice $120,000+ annually
Multiple Polyp Removal Documentation
When removing multiple polyps during colonoscopy, each polyp size, location, and removal technique must be documented. Cold forceps (45380), hot forceps (45384), and snare techniques (45385) have different reimbursement rates.
Missing polyp documentation reduces average colonoscopy reimbursement by 40%
Screening vs Diagnostic Colonoscopy
Medicare and commercial payers have strict rules differentiating screening colonoscopies (G0105, G0121) from diagnostic procedures (45378). If polyps are found during screening, coding changes to diagnostic with modifier PT, affecting patient cost-sharing.
Incorrect screening/diagnostic coding causes 28% of colonoscopy denials
ERCP Component Coding
Endoscopic retrograde cholangiopancreatography involves multiple billable components: diagnostic ERCP, sphincterotomy, stone extraction, stent placement. Each component requires precise documentation and appropriate add-on codes.
Incomplete ERCP component billing loses $2,000-4,000 per procedure
Pathology and Biopsy Coding Coordination
GI biopsies require coordination between endoscopy and pathology billing. Multiple biopsies from different sites need separate pathology codes. Global period rules affect timing of biopsy results billing.
Pathology coordination errors cost $8,000-12,000 monthly
ASC vs Hospital Outpatient Billing
Gastroenterology procedures billed in ambulatory surgery centers use different fee schedules than hospital outpatient departments. Facility fees, professional fees, and technical components must be properly separated.
ASC billing errors reduce facility revenue by 15-25%
Comprehensive GI Procedure Coverage
Expert billing across all gastroenterology procedures
Upper GI Endoscopy Procedures
Esophagogastroduodenoscopy (EGD) for diagnosis and treatment of upper GI conditions.
Diagnostic EGD
$420CPT 43235
Examination of esophagus, stomach, duodenum
EGD with Biopsy
$520CPT 43239
Includes tissue sampling
EGD with Dilation
$780CPT 43248
Esophageal stricture dilation
EGD with Band Ligation
$1,150CPT 43244
Variceal banding
Billing Note: Document scope type, sedation level, and all findings with precise anatomical locations.
Colonoscopy & Lower GI Procedures
Screening and diagnostic colonoscopies including polyp removal and biopsy.
Screening Colonoscopy
$580G0121
Average risk patient screening
Diagnostic Colonoscopy
$620CPT 45378
Diagnostic examination to cecum
Colonoscopy with Biopsy
$720CPT 45380
Single or multiple biopsies
Colonoscopy with Polypectomy
$880CPT 45385
Snare polyp removal
Billing Note: Track cecal intubation documentation, prep quality, and polyp removal techniques for each specimen.
ERCP & Advanced Procedures
Endoscopic retrograde cholangiopancreatography and related interventions.
Diagnostic ERCP
$1,850CPT 43260
Biliary/pancreatic duct imaging
ERCP with Sphincterotomy
$2,400CPT 43262
Sphincter incision
ERCP with Stone Removal
$2,800CPT 43264
Calculi extraction
ERCP with Stent Placement
$3,200CPT 43274
Biliary stent insertion
Billing Note: Document all attempted and completed components, fluoroscopy time, and contrast usage.
Capsule Endoscopy & Motility Studies
Non-invasive diagnostic procedures for GI tract evaluation.
Capsule Endoscopy
$950CPT 91110
Wireless capsule imaging
Esophageal Manometry
$480CPT 91010
Motility testing
Gastric Emptying Study
$420CPT 78264
Nuclear medicine study
Breath Test H. Pylori
$180CPT 78267
Urea breath testing
Billing Note: Ensure medical necessity documentation and appropriate pre-authorization for capsule endoscopy.
Therapeutic GI Procedures
Advanced therapeutic interventions for GI disorders.
PEG Tube Placement
$1,450CPT 43246
Percutaneous feeding tube
Hemorrhoid Banding
$380CPT 46221
Rubber band ligation
Liver Biopsy
$650CPT 47000
Percutaneous liver biopsy
Paracentesis
$280CPT 49082
Abdominal fluid drainage
Billing Note: Document indication, technique, imaging guidance used, and specimens sent for analysis.
GI Practice Success Stories
Real results from gastroenterology practices we've optimized
High-Volume Endoscopy Center Transformation
4-physician GI practice with dedicated ASCChallenge
Center was losing $45K monthly on improper polyp removal coding, bundling errors causing 15% denial rate, and inconsistent screening vs diagnostic colonoscopy documentation.
Solution
Implemented polyp-specific documentation templates, automated bundling validation, created screening/diagnostic decision flowcharts, and trained staff on Medicare colonoscopy rules.
Results
- ✓Colonoscopy average reimbursement increased from $620 to $810
- ✓Denial rate reduced from 15% to 2.1%
- ✓Captured $540,000 additional annual revenue
- ✓ASC facility fees optimized - 32% increase
ERCP Program Revenue Maximization
Advanced endoscopy program - therapeutic proceduresChallenge
Complex ERCP procedures being billed with single codes despite multiple components. Sphincterotomy, stone extraction, and stent placement components not separately billed. Average ERCP reimbursement $1,850 vs potential $3,200.
Solution
Created ERCP-specific procedure documentation checklist, trained physicians on component documentation, implemented real-time coding review for complex cases.
Results
- ✓ERCP average reimbursement increased 73% to $3,190
- ✓Component capture rate improved from 64% to 98%
- ✓Added $380,000 annual revenue from same case volume
- ✓Zero denials on ERCP component billing
Multi-Location GI Practice Standardization
7 locations with 12 gastroenterologistsChallenge
Inconsistent coding across locations, pathology billing disconnected from procedures, screening colonoscopy rules varying by location causing compliance issues.
Solution
Standardized documentation across all sites, integrated pathology billing coordination, implemented location-specific payer rule databases, centralized coding team.
Results
- ✓Coding consistency achieved across all 7 locations
- ✓Pathology coordination errors eliminated (was costing $96K annually)
- ✓Screening colonoscopy compliance: 100%
- ✓Practice-wide revenue increase of $720,000
Gastroenterology Billing Questions Answered
Expert answers to your GI billing questions
How do you handle the complex bundling rules for endoscopy procedures?
We maintain current NCCI edit databases and automated scrubbing systems that flag potential bundling issues before submission. Our GI coding specialists understand which procedures can be billed together (e.g., colonoscopy with multiple polypectomies using different techniques) and when modifier 59 is appropriate. We track CMS quarterly updates to bundling edits and immediately update our validation rules. For complex cases like ERCP with multiple therapeutic components, we provide real-time coding support to ensure all billable elements are captured while maintaining compliance.
What is your approach to screening vs diagnostic colonoscopy coding?
We implement clear decision algorithms based on CMS rules. If colonoscopy starts as screening (G0121) but polyps are found and removed, it converts to diagnostic (45380-45385) with modifier PT appended. We educate physicians on documentation requirements - the procedure note must clearly state 'started as screening' when applicable. For high-risk screening (G0105), we verify family history or prior polyp documentation. Our system automatically flags cases where screening indicators don't match the diagnosis codes. This precision prevents the 28% denial rate common in GI practices that don't specialize in these rules.
How do you maximize reimbursement for polyp removal during colonoscopy?
Polyp removal optimization requires detailed documentation of each polyp: size (mm), location (anatomical segment), removal technique (cold forceps, hot forceps, snare), and specimen sent to pathology. We create polyp logs that capture this data systematically. Cold forceps biopsy (45380) reimburses less than hot biopsy forceps (45384) which reimburses less than snare polypectomy (45385). When multiple polyps are removed using different techniques, we bill the highest-value code first with modifier 51 on subsequent codes. This attention to detail increases average colonoscopy reimbursement by 25-40%.
Can you handle ASC facility fee billing as well as professional fees?
Yes, we specialize in both professional and facility components for gastroenterology ASCs. Facility fees follow ASC fee schedules with different payment rates than hospital outpatient. We manage the technical component billing including room charges, supplies, drugs, and equipment. Professional fees are billed with modifier 26 when appropriate. We optimize both revenue streams - our clients see average 32% increase in facility revenue by properly coding all ASC components, using appropriate modifiers, and capturing all covered ancillary services like pathology.
How do you coordinate pathology billing with endoscopy procedures?
We implement integrated workflows linking endoscopy procedures to pathology specimens. Our system tracks: specimen collection during procedure, pathology accessioning numbers, number of specimens from each anatomical site, and pathology results. For multiple biopsies, we ensure separate pathology codes (88305 for each specimen jar). We coordinate with pathology labs to prevent duplicate billing and ensure timely claims submission. Global period rules are monitored so pathology results related to procedures aren't denied as included services. This coordination eliminates the $8,000-12,000 monthly losses typical from pathology billing errors.
What about ERCP billing - how do you capture all components?
ERCP procedures involve base diagnostic code (43260) plus separate codes for each therapeutic component: sphincterotomy (43262), stone removal (43264), dilation (43263), stent placement (43274), etc. We provide ERCP-specific documentation checklists ensuring physicians document what was attempted, what was successful, fluoroscopy time, contrast usage, and any complications. Each billable component requires specific documentation. Our real-time coding review catches missed components before claims submission. This systematic approach has increased our clients' ERCP reimbursement from average $1,850 to $3,190 per procedure.
Do you stay current with gastroenterology coding changes and payer policies?
Our GI coding team includes specialists with AAPC certification and specific gastroenterology training. We monitor quarterly CPT updates, annual RVU changes, and payer-specific policy modifications. Major recent changes include the 2021 colonoscopy screening rule clarifications, updated polyp removal code descriptors, and ERCP bundling edit modifications. We attend annual GI coding conferences and maintain relationships with national GI coding experts. When new procedures are introduced (like third-space endoscopy techniques), we research coding immediately and provide guidance to physicians.
How quickly can you improve our gastroenterology billing performance?
Most GI practices see immediate improvement in clean claim rates within 30 days as we implement procedure-specific validation. Coding optimization (proper polyp documentation, ERCP component capture) shows results within 45-60 days. Full revenue optimization including ASC facility fees, pathology coordination, and denial resolution typically achieves target metrics within 75-90 days. Our fastest case was an endoscopy center that saw colonoscopy reimbursement increase 31% within 45 days through polyp documentation improvement alone.
Optimize Your Gastroenterology Practice Revenue
Join hundreds of GI practices and endoscopy centers who have increased revenue by 26% with our specialized billing services. Get a free revenue analysis today.
✓ GI coding specialists ✓ ASC billing expertise ✓ Pathology coordination