How do you determine whether a colonoscopy is screening or diagnostic?

We review the indication in the documentation — patient history, symptoms, and prior findings. If a screening colonoscopy results in polyp removal, most payers still classify it as screening, but we verify payer-specific rules because they vary.

Do you handle ASC facility billing as well as professional billing?

We specialize in professional billing. For ASC facility billing, we coordinate closely with the facility billing team to ensure alignment and prevent duplicate or conflicting claim submissions.

How do you handle billing when multiple procedures are performed in one session?

We apply the appropriate bundling rules and add-on codes — and where multiple separately billable procedures are supported by documentation, we bill them correctly to capture the full value of the session.

Do you handle ERCP and advanced endoscopy billing?

Yes. We have experience with the full range of GI procedures including ERCP, endoscopic ultrasound, capsule endoscopy, and hemorrhoid banding — applying the appropriate codes for each.

What is your denial rate for GI clients?

While results vary by payer mix and procedure type, our GI clients typically see significant reductions in denial rates within 60–90 days of onboarding. We track and report your denial metrics monthly.

Specialty Billing

Gastroenterology Billing Services

Specialized billing for endoscopy, colonoscopy, and the complex coding landscape of gastroenterology practice.

Schedule Free Consultation Request Free Evaluation

Gastroenterology Billing Overview

Gastroenterology billing is among the most technically complex in outpatient medicine. Endoscopic procedures require precise CPT code selection based on the extent and nature of each procedure, and the bundling rules between diagnostic and therapeutic components create ongoing coding challenges. Add the volume of colonoscopy screening and surveillance billing — where screening vs. diagnostic status directly affects patient cost-sharing — and GI practices face a billing environment that rewards expertise and penalizes errors heavily. At 2 Lee's Billing, our certified coders understand GI-specific coding, including endoscopy base codes, add-on procedures, anesthesia rules, and facility vs. professional component billing — for both office-based and ASC settings.

Coding Highlights

✓Colonoscopy codes: 45378–45398 (diagnostic, therapeutic, polyp removal)
✓Upper endoscopy (EGD): 43235–43259 series
✓Screening vs. diagnostic colonoscopy billing and ABNs
✓Add-on procedure coding for multiple polyp removal
✓Capsule endoscopy — 91110, 91111
✓ERCP procedure codes — 43260–43278
✓Anesthesia billing coordination for endoscopy suites

Common Gastroenterology Billing Challenges

Screening vs. Diagnostic Colonoscopy

Whether a colonoscopy is classified as screening or diagnostic has significant implications for patient cost-sharing. Incorrect classification results in patient billing complaints, refund requests, and payer audits.

Polyp Removal Coding

Multiple polyp removal during a single session requires understanding of which techniques were used (hot biopsy, cold snare, EMR) and how to code each correctly — including add-on codes.

Bundling & Unbundling Rules

When diagnostic and therapeutic procedures are performed during the same endoscopy session, complex bundling rules determine what can be billed separately and what must be included.

Prior Authorization for Endoscopy

Most commercial payers require prior authorization for elective endoscopic procedures. Missed authorizations result in denials with limited appeal options.

ASC vs. Office Billing

GI practices performing procedures in an ASC vs. an office-based suite face different coding and billing rules. The wrong setting designation causes payer mismatches and denials.

Anesthesia Coordination

When anesthesia is administered separately for endoscopy, coordination of billing between the GI practice and the anesthesia provider can create claim conflicts or patient balance disputes.

How 2 Lee's Billing Supports Gastroenterology Practices

✓

Endoscopy Procedure Coding

We apply the correct CPT codes for every endoscopic procedure — including therapeutic add-ons, extent of examination, and technique-specific codes for polypectomy and resection.

✓

Screening vs. Diagnostic Determination

We carefully classify each colonoscopy based on the indication and findings — applying the correct modifier (PT) and payer-specific rules to minimize incorrect patient billing.

✓

Prior Authorization Management

We identify and obtain prior authorizations for scheduled procedures — preventing authorization denials before they happen.

✓

Office & ASC Billing

We correctly handle both office-based and ASC procedure billing — with the appropriate facility and professional component designations for each setting.

✓

Denial Appeals

GI denials are frequently linked to coding decisions or authorization requirements. We review and appeal every denial with supporting documentation and clinical rationale.

✓

AR Monitoring

Endoscopic procedures carry high reimbursement values — making AR aging especially costly in GI practices. We monitor and follow up on all unpaid claims systematically.

Gastroenterology Billing FAQs

Related Services

Medical Billing & Coding Denial Management Accounts Receivable Management Verification of Benefits

Other Specialties

General Surgery ASC Primary Care Pain Management

GI Billing Is Complex — Your Billing Partner Shouldn't Be

Get a free assessment of your current GI billing and find out where you may be leaving revenue on the table.

Request Free Evaluation Schedule Free Consultation

Or call us: (702) 478-8115 · Toll Free: (800) 364-1801