What we handle for gastroenterology practices
Billers are assigned by specialty, so the person working your claims already knows your codes and your payers.
Colonoscopy
Screening and diagnostic colonoscopy distinguished correctly, with modifier PT or 33 applied when a screening converts.
Upper endoscopy
EGD with biopsy, dilation or removal coded to what was actually performed.
Infusion therapy
Biologic infusions billed with correct J-codes, units and administration time.
Anesthesia coordination
Monitored anesthesia care claims aligned with the endoscopy claim so they do not deny as unnecessary.
Where gastroenterology claims usually go wrong
These are the four issues we see most often when we take over a gastroenterology practice.
Screening that becomes diagnostic
If a polyp is removed during a screening colonoscopy, the claim needs modifier PT or 33 or the patient is billed a deductible they should not owe.
Infusion units and waste
J-code units must match the vial size and documented waste. Mismatches are a common audit target.
Bundled endoscopy components
Biopsy and removal at the same site often bundle. Billing them separately without justification causes takebacks.
Anesthesia medical necessity
Some payers only cover MAC for endoscopy in defined circumstances. We check before the claim goes out.
How we work
Eligibility, every day
Every next-day scheduled patient is verified for active coverage before the visit.
Charges validated
Codes and documentation are checked after the note is signed, before the claim is submitted.
Denials appealed
Every denial is reviewed, corrected and resubmitted. Nothing is written off by default.
Monthly reporting
Paid claims and AR aging reports so you can see exactly where your money is.
Gastroenterology billing questions
Something not covered here? Call (833) 305-5528.
Do you handle infusion and biologic billing?
Yes, including J-code selection, units and documented waste.
Can you bill for an ambulatory surgery centre?
Yes. Facility and professional claims are billed separately and we handle both.
What about anesthesia claims?
We coordinate them with the procedure claim so they are not denied as unnecessary.