Confirms coverage and documents screening versus diagnostic intent before the colonoscopy or EGD is scheduled, since that decision determines which modifier the claim needs later.
Gastroenterology Medical Billing Services
Gastroenterology Medical Billing Services for Colonoscopy, EGD & ERCP Claims
From screening and diagnostic colonoscopies to EGD, ERCP, capsule endoscopy, and biologic infusions for IBD, we bill every corner of a GI practice.
Certified Billing & Coding Support
HIPAA-Conscious Workflows
Colonoscopy & EGD Claims
Most Billing Software Supported
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How We Help
What We Handle for GI Practices
Thrive manages the billing side of your gastroenterology practice so your physicians can stay focused on patients instead of chasing payers. That means coding every colonoscopy and EGD by the polypectomy or biopsy technique actually used, applying modifier PT or 33 correctly the moment a screening procedure turns diagnostic, and following up on every claim until it is paid or resolved.
Practices that choose Thrive as their gastroenterology medical billing company get a team that already knows screening conversion rules, NCCI bundling edits, and biologic infusion documentation, instead of a generalist biller treating every endoscopy the same way. Whether your practice is general GI, an advanced endoscopy program, or a hepatology practice, the coding rules overlap enough to share one trained team and diverge enough that generalist billers consistently get them wrong.
HIPAA Compliant
Certified Professional Coders
Nationwide Payer Coverage
95%+ clean claim rate across colonoscopy, EGD, and ERCP claims submitted the first time
Claims out the door within 48 hours of a completed encounter
AR held under 30 days on average instead of aging past 60 or 90
Practices typically see a revenue lift approaching 30% after onboarding
Gastroenterology Medical Billing and Coding Services
End-to-End Gastroenterology Revenue Cycle Management
Gastroenterology billing services carry a wide procedure mix in a single visit, screening and diagnostic endoscopy, biopsy, polypectomy, and increasingly biologic infusion for IBD. Here is what we handle from the first eligibility check to the final payment.
Eligibility & Benefit Verification
Prior Authorization
Secures and tracks authorization for capsule endoscopy, ERCP, manometry, and biologic infusions across commercial and Medicare Advantage plans.
Claims Submission & Scrubbing
Checks every colonoscopy and EGD code against polypectomy technique, biopsy site, and modifier requirements before a claim leaves the building.
Denial Management & Appeals
Traces denials to their actual cause, whether a PT or 33 mismatch or a bundling edit, and appeals with the operative documentation each payer requires.
AR Follow-Up
Works open claims on a set schedule so endoscopy and infusion balances do not sit past 30 days unattended.
Patient Statements & Collections
Bills patients clearly when a screening procedure converts to diagnostic, since that shift can change what the patient owes under their plan.
Payment Posting & Reconciliation
Reconciles biologic infusion reimbursement against the actual dose administered, so drug cost overruns get caught early.
Credentialing & Payer Enrollment
Keeps gastroenterologists credentialed and enrolled with the payers your patients actually carry.
Reporting
Regular reporting on claim status, denial trends, and AR aging broken out by endoscopy, infusion, and diagnostic test categories.
Gastroenterology Billing Codes
Gastroenterology CPT and HCPCS Coding Reference
A quick reference to how gastroenterology billing codes are organized, not a substitute for chart documentation. Useful for seeing where a specific claim fits before it is coded.
- 99202 - 99215
E/M Office Visits
New and established patient visits for GI symptom evaluation and treatment planning
- 45378 - 45398
Colonoscopy
Diagnostic and therapeutic colonoscopy including biopsy, polypectomy, submucosal injection, and control of bleeding
- 44388 - 44408
Colonoscopy Through Stoma
Diagnostic and therapeutic colonoscopy performed through a surgical stoma rather than the rectum
- 45330 - 45346
Sigmoidoscopy
Diagnostic and therapeutic examination of the rectum and sigmoid colon, coded separately from a full colonoscopy
- 43235 - 43259
Upper Endoscopy (EGD)
Diagnostic and therapeutic examination of the esophagus, stomach, and duodenum, including biopsy, dilation, and bleeding control
- 43260 - 43278
ERCP
Endoscopic retrograde cholangiopancreatography for biliary and pancreatic duct diagnosis and treatment
- 91110 - 91113
Capsule Endoscopy
Small bowel wireless capsule imaging used after inconclusive EGD and colonoscopy findings
- 91010 - 91037
Esophageal Manometry & pH Monitoring
Motility and acid exposure testing for dysphagia, achalasia, and reflux evaluation
- 91132 - 91133
Gastric Motility Testing
Electrogastrography and gastric emptying studies used to evaluate gastroparesis
- 91200
Liver Elastography
Non-invasive liver stiffness measurement used to stage fibrosis without a liver biopsy
- 47000 - 47001
Liver Biopsy
Percutaneous liver biopsy for tissue diagnosis of liver disease
- 99151 - 99157
Moderate Sedation
Sedation services provided by the same physician performing the endoscopic procedure
- J-Codes
Biologic Infusion Administration
Injectable biologics for Crohn's disease and ulcerative colitis, billed by specific drug and weight-based dose
What is the difference between modifier PT and modifier 33?
Both signal that a screening colonoscopy became diagnostic or therapeutic after a polyp was found and removed, but they apply to different payer types. Modifier PT applies to Medicare claims. Modifier 33 applies to commercial and Medicaid plans. Using the wrong one is one of the most common and most avoidable colonoscopy denials, since the modifier itself tells the payer's system which cost-sharing rule to apply.
Why does polypectomy technique matter for coding?
Colonoscopy reimbursement in gastroenterology is driven by the specific technique used to remove a polyp, not just whether one was removed. Cold forceps, hot forceps, cold snare, and hot snare each map to a different CPT code and a different payment level. The operative note has to state the technique used, and the code billed has to match it exactly.
Denial Patterns
What Causes Gastroenterology Claim Denials
These are not generic billing problems. Each one is specific to how payers adjudicate colonoscopy, endoscopy, and infusion claims.
Screening-to-Diagnostic Modifier Errors
The wrong modifier, or no modifier at all, when a screening colonoscopy converts to therapeutic after a polyp is found and removed causes an automatic denial and can leave the patient billed incorrectly for a preventive service.
Biopsy and Polypectomy Bundling Denials
Billing a biopsy and a polypectomy performed at different sites in the same colonoscopy without modifier 59 or XS support gets denied as an unbundled service under NCCI edits.
Discontinued Procedure Denials
A colonoscopy stopped before reaching the cecum due to poor bowel prep or patient intolerance billed without modifier 52 gets processed as a completed procedure, creating both a denial risk and an overpayment exposure.
Missing Prior Auth on Advanced Diagnostics
Capsule endoscopy, esophageal manometry, and ERCP billed without payer pre-approval get denied outright, regardless of how clearly medically necessary the test was.
Polypectomy Technique Mismatch
Coding a polyp removal as snare when the operative note documents hot forceps, or the reverse, does not match the code billed to the technique performed and triggers a downcode or denial on review.
Biologic Infusion Denials for IBD
Infliximab and other biologic infusions for Crohn’s disease or ulcerative colitis are denied without documented step therapy failure and current weight-based dosing on file before the infusion.
Moderate Sedation Billing Errors
Billing sedation separately when it is bundled into the base endoscopic procedure, or missing documentation supporting medically necessary monitored anesthesia care, causes denial or recoupment.
Diagnostic Test Frequency Edits
Repeat stool-based screening tests or surveillance colonoscopies billed before the payer’s allowed interval has elapsed are denied regardless of the clinical reason for repeating them.
Our Process
Our Gastroenterology Billing Process
Every step below exists because of a specific denial pattern above. Nothing here is generic.
Eligibility & Screening Intent Verification
We confirm coverage and document screening versus diagnostic intent before the procedure happens, since that decision drives the entire billing path afterward.
GI-Trained Coding Review
Every claim is coded by billers who track polypectomy technique, biopsy sites, and screening conversion rules daily, not generalists rotating across unrelated specialties.
Pre-Submission NCCI & Modifier Scrubbing
Claims are checked for PT and 33 accuracy, modifier 59 or XS support, and bundling edits before they reach a payer, catching the errors that cause the most denials.
Clean Claim Submission
Corrected claims go out within 48 hours, keeping your gastroenterology billing cycle moving instead of sitting in a queue.
Denial Root-Cause & Appeal
Any denial is traced to its actual cause, a modifier mismatch, a bundling edit, or a missing prior authorization, and appealed with the documentation that specific payer requires.
AR Follow-Up & Reporting
Outstanding claims are worked on a set follow-up schedule until resolved, with regular reporting back on where your numbers stand.
Why Thrive
Why Gastroenterology Practices Choose Thrive
Practices that switch to Thrive get a gastroenterology medical billing company built around endoscopy coding and screening conversion rules specifically, not generic revenue cycle coverage stretched across every specialty.
GI-Focused Coding Expertise
Coders who track polypectomy technique, screening conversion rules, and biopsy site documentation daily, not as one specialty among a dozen others.
HIPAA Compliance at Every Step
Patient data is handled under strict HIPAA safeguards across intake, coding, and reporting, regardless of practice size.
Nationwide Payer Experience
Claims experience across Medicare, Medicare Advantage, and commercial payers in all 50 states, not just regional plans.
Transparent, Regular Reporting
You get consistent visibility into claim status, denial trends, and AR aging, communicated directly by your billing team.
Audit-Ready Documentation
Coding and modifier decisions are documented in a way that holds up if a payer ever asks questions later, which matters most given how closely screening-to-diagnostic claims get reviewed.
Talk to a Specialist
Talk to a Gastroenterology Billing Expert
We will look at your current claim volume, denial patterns, and procedure mix, endoscopy heavy, infusion heavy, or general, and put together a custom fee schedule and a revenue recovery estimate. No obligation.
- Free 15-Minute Practice Revenue Review
- Custom fee schedule based on your claim volume and procedure mix
- No disruption to your current documentation process
Request a GI Billing Review
Get a focused review of the billing steps behind your gastroenterology claims, from pre-procedure checks through payer follow-up.
🔒 100% confidential. We never sell your data. Privacy Policy
FAQ
Gastroenterology Billing FAQs
How much does gastroenterology medical billing cost?
Fee structures are typically based on a percentage of collections and are set after we review your claim volume and procedure mix, since a practice with a high volume of colonoscopies and infusions bills very differently than a diagnostic only office. You get a custom fee schedule after your Free 15-Minute Practice Revenue Review, with no obligation to sign anything.
How long does onboarding take?
Most gastroenterology practices are fully onboarded within one to two weeks. We start with a free billing audit to see where claims are getting stuck, then align our coding and submission workflow to your current documentation process, with no disruption to your daily schedule during the switch.
Can you take over our existing AR and open claims?
Yes. We review your open AR, including anything already aged past 30 or 60 days, and prioritize the claims most likely to be recovered first. Older colonoscopy, ERCP, and infusion claims often still qualify for appeal well past their original denial date.
Do you bill screening colonoscopies that convert to diagnostic correctly?
Yes. Our coders apply modifier PT on Medicare claims and modifier 33 on commercial and Medicaid claims whenever a screening colonoscopy converts to diagnostic or therapeutic after a polyp is found, so the claim reflects the correct cost-sharing rule and does not deny on a modifier mismatch.
How do you handle denied claims and appeals?
Every denial is traced back to its actual cause, a modifier mismatch, an NCCI bundling edit, or a missing prior authorization, before we resubmit anything. We then file the appeal with the documentation that specific payer requires, rather than resending the same claim and hoping for a different result.
Is our patient data handled securely?
Yes. Patient data is handled under HIPAA safeguards across intake, coding, and reporting, and our billing team follows the same compliance standards regardless of practice size or claim volume.
How do we track our numbers?
You receive regular reporting covering claim status, denial trends, and AR aging, plus a direct line to your billing team any time you have a question about a specific claim. Nothing about your numbers lives in a black box you have to dig through yourself.
Do you work with gastroenterology practices in every state?
Yes. Our team supports general gastroenterology, advanced endoscopy, and hepatology practices across all 50 states and works with Medicare, Medicare Advantage, and commercial payers nationwide. Your location does not change how thoroughly we work your claims or how quickly you get paid.
Free Revenue Analysis
Get a Clearer View of Your GI Revenue Cycle
When colonoscopy claims, procedure denials, authorization gaps, patient balance questions, or old AR keep resurfacing, the problem is usually bigger than one unpaid claim. Thrive can review the workflow and show where your GI billing process needs tighter follow-up.
- HIPAA Compliant
- Certified Billing & Coding Support
- No Forced Software Migration
- Nationwide Support